Transcarotid balloon valvuloplasty for critical aortic valve stenosis at the bedside via continuous transesophageal echocardiographic guidance

Abstract

We describe the first two successful cases of transcarotid balloon aortic valvuloplasty for critical aortic valve stenosis in the neonate utilizing continuous transesophageal echocardiographic guidance performed at the bedside. This method obviates the need for transporting a sick and hemodynamically unstable neonate to the catheterization laboratory and additionally reduces costs without compromising clinical care.

Transcarotid balloon valvuloplasty in neonates and small infants with critical aortic valve stenosis utilizing continuous transesophageal echocardiographic guidance: A 22 year single center experience from the cath lab to the bedside

“…This is a retrospective review and the first two patients were included in a previously published case report . In theory, performing a prospective randomized trial comparing our technique with surgical aortic valve repair would be ideal but in reality would require a multicenter trial and many years to accomplish.…”

“…We have previously described our initial experience with transcarotid balloon valvuloplasty (TCBV) with continuous transesophageal echocardiographic (cTEE) guidance for critical neonatal aortic valve stenosis (AS) . Other centers have described performing balloon valvuloplasty for critical AS utilizing various approaches including the axillary artery , umbilical vein , umbilical artery , femoral artery or vein , scapular artery , and transcarotid .…”

Congenital Aortic Stenosis in Childhood

“…The right carotid artery was firstly used based on the extensive experience with carotid artery cannulation for extracorporeal membrane oxigenation in newborns (Fischer et al, 1990). it is reported to be effective and safe, and it allows performing the entire procedure at the bedside with the aid of continuous transesophageal echocardiographic guidance, thus avoiding the use of fluoroscopy (Weber et al, 2000). Its disadvantages include the risk of carotid artery injury with potential neurologic complications and the need of surgical exposure.…”

Balloon dilation of neonatal critical aortic valvar stenosis via the umbilical artery

“…The procedure can also be performed at the bedside under continuous transoesophageal echocardiographic guidance. 9 Compromise of the carotid artery is currently reduced by using balloon catheters with low profiles. Cerebral lesions, nonetheless, remain an ongoing concern using this approach.…”