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Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management
C M Baker1, F X McGowan, J F Keane
1Department of Cardiology, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Journal of the American College of Cardiology
|November 18, 2000
Summary
Pulmonary artery trauma during balloon dilation is linked to pulmonary hypertension and can be fatal, especially with unconfined tears. Coil embolization of the damaged artery may prevent fatal hemorrhage.
Area of Science:
- Cardiology
- Interventional Radiology
- Pulmonary Medicine
Background:
- Balloon dilation (BD) is crucial for treating peripheral pulmonary stenosis.
- Controlled tears are necessary for successful BD, but excessive tearing can lead to severe complications.
- The incidence and optimal management of pulmonary artery trauma during BD are not well-documented.
Purpose of the Study:
- To review the management and outcomes of patients who experienced pulmonary artery (PA) trauma during balloon dilation (BD).
Main Methods:
- A review of patient records from June 1984 to October 1997 who underwent branch PA dilation.
- Analysis of cases with significant complications, including PA trauma.
Main Results:
- Pulmonary artery trauma occurred in 29 catheterizations (2.25%) across 26 patients.
- Tears were most often distal to the stenosis (62%).
- Six deaths resulted from pulmonary hemorrhage; PA trauma was associated with pulmonary hypertension.
Conclusions:
- Pulmonary artery trauma during BD is often distal, linked to pulmonary hypertension, and has a high fatality rate (42%) for unconfined tears.
- Intensive management and careful balloon placement may decrease incidence and mortality.
- Coil occlusion of the damaged PA is a promising strategy to prevent fatal hemorrhage.
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