RIGHT SUBSCAPULAR ARTERY CATHETERIZATION FOR BALLOON VALVULOPLASTY OFCRITICAL AORTIC-STENOSIS IN INFANTS

This study wets performed to evaluate the utility and safety of cathet erizing the right subscapular artery for balloon valvuloplasty of crit ical aortic stenosis in infants, Twenty-one patients, age 20 days to 1 7 months, underwent attempted valvuloplasty through the surgically exp osed right subscapular artery. Five or 7Fr catheters with balloon diam eters of 7 to 10 mm were used. Valvuloplasty was successfully performe d using this approach in 11 patients, In 2 other patients, the subscap ular artery would not accommodate the balloon angioplasty catheter (7F r), and the arteriotomy was extended Into the axillary artery, In thes e 13 patients, the peak systolic pressure gradient across the aortic v alve was decreased from 85 +/- 23 to 33 +/- 7 mm Hg, Moderate aortic r egurgitation developed in 3 patients. In the remaining 8 patients, val vuloplasty could not be performed through the right subscapular artery , In 2 patients, the right subclavian artery was anomalous and led to the descending aorta. In 6 small patients, no catheter could be advanc ed across the aortic valve. In 1 of these patients, a guidewire perfor ated a coronary sinus of Valsalva causing death, Overall, valvuloplast y using the right subscapular arterial approach was successful in 13 o f 19 infants (68%) with normal right subclavian arteries, including al l 10 such patients weighing greater than or equal to 5.5 kg, No clinic ally significant peripheral vascular complications or brachial plexus injuries occurred, Thus, the right subscapular arterial approach is an alternative route to be considered when planning balloon aortic valvu loplasty in infants.