Surgical cutdown of the right carotid artery for aortic balloon valvuloplasty in infancy: Midterm follow-up

A vascular approach for balloon aortic dilatation in infants is of major concern due to the high risk of femoral artery injury. To overcome this problem, a surgical right carotid artery (RCA) approach has been advocated. No reports are available on RCA after neonatal cutdown. Since 1990, RCA cutdown has been performed in 29 infants with congenital aortic stenosis. Periprocedural complications included one asymptomatic occlusion and one transient trauma of the stellate ganglion. At a mean follow-up of 4.4 +/- 2.2 years from aortic valvuloplasty, ultrasound assessment of morphology and flow of RCA was performed in 17 children. RCA was patent in all patients. The mean ratio of right/left carotid artery diameter was 0.95 +/- 0.16 (range 0.65-1.2). The site of surgical incision could be identified in 5 children in the absence of flow disturbance. A 6-year-old asymptomatic girl, who underwent two procedures, had a 35% reduction of RCA diameter at the site of cannulation and turbulent flow at Doppler interrogation, indicating mild obstruction. Our data demonstrate that RCA is well preserved after neonatal surgical cutdown: asymptomatic obstruction can occasionally be present.