Page 33 - Journal of Structural Heart Disease Volume 4, Issue 5

Case Report
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:228-233
DOI: https://doi.org/10.12945/j.jshd.2018.041.17
Received: October 06, 2017 Accepted: November 12, 2017 Published online: October 2018
Retrieval of a Partially Deflated Balloon: A Novel Approach
Stephen Nageotte, MD, MBA*, Cheryl Takao, MD
Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
Abstract
A rare complication of balloon dilation in the cath- eterization laboratory is the inability to deflate the bal- loon catheter. In the literature, methods described for deflating the balloon all involve puncture or rupture of the balloon while it is within the patient. Here we pres- ent a case in which a novel approach was used in order to puncture and deflate the balloon outside of the pa- tient. We further looked at how balloons rupture when overinflated and the potential risks associated with do- ing this inside of a patient.
Copyright © 2018 Science International Corp.
Key Words
Catheterization • Pulmonary artery stenosis • Balloon malfunction
Introduction
The inability to deflate an angioplasty balloon is a known, albeit uncommon, complication of balloon dilation procedures. Typically, methods for balloon deflation in the literature include over-inflation of the balloon in order to rupture it, inserting the stiff end of a wire through another catheter in order to puncture the balloon or insertion of a needle through the chest wall. These procedures are potentially a high risk in that they involve either rupture of the balloon within the patient or transcutaneous needle puncture. We describe a case in which an alternative approach was used for retrieval of a partially deflated balloon.
Case Presentation
A 3-year-old female with a history of tetralogy of Fallot with Pulmonary Atresia status-post full repair presented with significant continued branch Pulmo- nary Artery (PA) stenoses. Her past medical history in- cluded being an ex-28 week premature infant, chron- ic lung disease, central sleep apnea, and right femoral vein thrombosis. She had two previous cardiac sur- geries (a modified Blalock-Taussig shunt (BTS) in the neonatal period; central pulmonary arterioplasty and VSD repair with 14mm RV to PA conduit at 9 months of age). She also had three previous catheterizations which included angioplasty of left (L)PA and right (R) PA, as well as implantation of a Valeo 9mm x17mm stent (Bard Peripheral Vascular, Tempe, AZ) in the LPA, mounted on a 7mm balloon. Despite this, she had evidence of continued branch PA stenosis with RPA peak gradient of 43 mmHg and LPA peak gradient of 46 mmHg by echocardiogram. She was referred to the catheterization laboratory to evaluate her branch PAs with possible angioplasty and/ or stent implantation.
In the catheterization laboratory, access was first obtained in the right internal jugular vein with a 4 Fr sheath and the left femoral vein with a 6 Fr sheath, as the patient had a history of right femoral vein occlu- sion. Initial hemodynamics showed the RV pressure to be 82% of the systemic pressure and there was signif- icant intimal proliferation within the LPA stent down to 4.1mm compared to 6.7mm distally. A 0.018” Plati- num Plus Guidewire (Boston Scientific Corp., Marlbor-
* Corresponding Author:
Stephen Nageotte, MD, MBA
Division of Cardiology, Department of Pediatrics
Children's Hospital of Los Angeles
4650 W. Sunset Blvd., Mailstop #34, Los Angeles, CA 90027, USA
Tel. +1 323 361 8308; Fax: +1 323 361 1513; E-Mail: steve.nageotte@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISN 2326-4004
Accessible online at:
http://structuralheartdisease.org/