Pediatric Cardiology and Cardiac Surgery
Vol.24 No.1 2008 (11-16)

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Hiroshi Nishikawa, Kinya Kubota, Naoki Ohashi, and Masaki Matsushima

Department of Pediatric Cardiology, Social Insurance Chukyo Hospital, Nagoya, Japan


Background: In balloon aortic valvuloplasty (BAV) for congenital aortic stenosis (AS) it is technically difficult to maintain the balloon in the appropriate position during expansion because of cardiac contraction and pulsatile blood flow from the left ventricle.
Purpose: To report the technical change in BAV caused by the method of femoral artery approach used in our institution.
Methods: We reviewed 11 instances of BAV performed by the femoral artery approach in 7 cases in this institution.
Results: We first used a single balloon with a short sheath for BAV. The balloon was not stable at the aortic valvular level, and we changed from the single balloon method to a double balloon method. However, it was still difficult to maintain the balloon’s position at the valvular level. We then began to use an established long sheath with the single and double balloon methods. The balloon position stabilized with the long sheath. However, the sheath kinked at the region of the aortic arch, causing difficulty in reinsertion of the balloon. We then introduced a long sheath that we had molded to a J-shape in each case. The J-shaped long sheath reduced balloon displacement and sheath kinking in the aortic arch, and we were able to perform stable BAV.
Conclusions: We conclude that the J-shaped long sheath is a safe, useful device for BAV.