Author + information
- Igor V. Buzaev1,
- Vladimir V. Plechev1,
- Irina E. Nikolaeva1,
- Dmitry V. Onegov2,
- Artur R. Sharafutdinov2,
- Gulchachak A. Halikova2,
- Bogdan Aleksandrovich Oleynik3 and
- Rezida Galimova1
Patient initials or identifier number
Relevant clinical history and physical exam
A 14 days old newborn boy was admitted to the hospital with diagnosis critical aortic stenosis with weight 3,3 kg and body surface area 0.22 m2. Unstable hemodynamics. Arterial blood pressure 80/60. Systolic murmur on aortic valve.
Relevant test results prior to catheterization
Echocardiography: Bicuspid aortic valve, thick cusps decreased opening motion, peak gradient 95 mmHg on aortic valve. Aortic valve ring 9 mm. EDV 1.8 cm. EF 73%. Aortic regurgitation (+), mitral regurgitation (+++), foramen oval 0.2 cm.
Relevant catheterization findings
Aortic valve ring 9 mm.
A femoral arterial access (5F). Catheter AR1 has been positioned in ascending aorta. Angiogram. A lot of tries to put the tip of BMW, PILOT 150 wires on AR1-3, XB, JR3-4 catheters was unsuccessful because the thin aortic valve aperture (1-2 mm). Femoral venous access has been performed (5F). MPA catheter used to pass through foramen ovale to LA and has been replaced on the wire to the XB4. Pilot 150 wire has been delivered to the LV and then by the blood flow to aorta. At this step hemodynamics of the patient became worse. We tried to deliver the balloon to aortic valve from venous side, but it resulted in tension of the system while passing the LV U-turn and we stopped to avoid the wire loss. Wire has been captured in abdominal aorta by Gooseneck retriever and has been withdrawn from arterial access. Quantum Maverick 5 x 20 RX has been delivered to the aortic valve from arterial side taking into consideration the sharp end of the wire in LV, then 16 atm predilation. Wire and balloon has been withdrawn and patient has been stabilized in 7 minutes. Echocardiography: MR was decreased to 2, no separation of pericardium, GP was 70 mm Hg. AR1 catheter has been used from arterial side and PILOT 150 easily has been passed through the valve to LV and final balloon valvuloplasty has been done with TYSHAK 10 x 30. The result is 9 mm Hg aortic valve gradient with decrease of MR, AR (++), no complications. Extubation in 10 hours and discharge from ACU in 24 hours.
1. In aortic valve balloon valvulo plasty in a newborn with critical aortic valve stenosis, transseptal approach can be an effective alternative if it is impossible to pass the wire from an arterial side
2. It is difficult to deliver the balloon to the aortic valve from the venous side because of angulations on the way, that is why is useful to capture the wire from an arterial side and use balloon from the arterial side of the wire
3. This procedure can be done safely without any complication taking into consideration some cautions (chords of the mitral valve, stiff side of the wire).