Fischer D R, Ettedgui J A, Park S C, Siewers R D, del Nido P J
Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania.
J Am Coll Cardiol. 1990 Jun;15(7):1633-6. doi: 10.1016/0735-1097(90)92839-t.
Balloon valvuloplasty in neonates with severe aortic valve stenosis is limited by difficulties in catheter manipulation around the arch and across the valve and by the risk of femoral artery complications. A right common carotid artery cutdown was utilized for balloon aortic valvuloplasty in five neonates 1 to 20 days of age, weighing 3.1 to 3.9 kg. Standard balloon valvuloplasty was performed through a 6F sheath inserted in the right carotid artery. The arteriotomy was repaired at the end of the procedure. Mean left ventricular systolic pressure was reduced from 142 to 97 mm Hg, with a decrease in mean peak systolic pressure gradient from 76 to 33 mm Hg. Only one patient developed mild aortic regurgitation. One patient with a hypoplastic left ventricle died, and one patient required open valvotomy. All four survivors have a normal carotid pulse and no neurologic sequelae. Two of these patients required repeat balloon dilation to treat residual aortic valve stenosis at 8 and 10 months of age, respectively. Balloon valvuloplasty using a carotid artery approach is feasible and was safe in five neonates with severe aortic valve stenosis.
在主动脉弓周围和跨越瓣膜进行导管操作存在困难，以及存在股动脉并发症的风险。对5名年龄在1至20天、体重3.1至3.9千克的新生儿采用右颈总动脉切开术进行球囊主动脉瓣膜成形术。通过插入右颈动脉的6F鞘管进行标准的球囊瓣膜成形术。手术结束时修复动脉切开处。左心室平均收缩压从142毫米汞柱降至97毫米汞柱，平均收缩压峰值梯度从76毫米汞柱降至33毫米汞柱。仅1例患者出现轻度主动脉瓣反流。1例左心室发育不全的患者死亡，1例患者需要进行开放性瓣膜切开术。所有4名存活者颈动脉搏动正常，无神经后遗症。其中2例患者分别在8个月和10个月大时需要再次进行球囊扩张以治疗残余的主动脉瓣狭窄。采用颈动脉入路的球囊瓣膜成形术在5例患有严重主动脉瓣狭窄的新生儿中是可行且安全的。
