Valvuloplasty balloon detaching from the stem of a catheter

A 12-year-old boy underwent pulmonary balloon valvotomy for isolated critical pulmonary stenosis. Following valvotomy, blood was found to be drawn into the syringe during deflation of the balloon, so a provisional diagnosis of a burst balloon was made. However, when the balloon catheter was withdrawn, the balloon got detached from the stem of the catheter at the level of the right atrium and was retained over the exchange guidewire. The balloon, when retrieved with a snare, was found to be intact. The balloon may have been partially detached at the junction of the proximal end of the balloon and the catheter; hence, blood was drawn from the catheter during deflation. In our institution balloons are reused following sterilization with ethylene oxide gas. We conclude that any balloon presumed to have burst inside the heart must be removed with great caution. In a third world country like India, where cost is an important factor, balloons can be reused, but with caution, keeping in mind complications such as in this case.