Pulmonary artery tears following balloon valvotomy for pulmonary stenosis

Tears involving the anterior supravalvar annulus developed in 2 children and an infant following percutaneous balloon pulmonary valvotomy using oversized balloons. The 3 patients had angiographic features of three different types of stenotic valves: usual pulmonary valve stenosis in 1, a form of dysplastic pulmonary valve with supravalvar narrowing in a second, and a doming valve in a neonate. All had a successful reduction in right ventricular outflow tract gradient following the procedure. The pulmonary arterial tears were not associated with balloon rupture or clinical symptoms. It is postulated that the relative deficiency of elastic fibers in the supravalvar commissure makes this site relatively vulnerable to intimal tearing.