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Caveats of balloon dilation of conduits and conduit valves
G J Ensing1, D J Hagler, J B Seward
1Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Percutaneous balloon dilation can reduce obstruction in right ventricle to pulmonary artery conduits, avoiding or delaying surgery in most patients. However, complications like balloon rupture can occur.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiac Surgery
Background:
- Stenosis of prosthetic conduits (right ventricle to pulmonary artery) and grafts (right atrium to pulmonary artery) is a common complication after Fontan procedures.
- This obstruction can lead to increased right ventricular pressure and systemic venous congestion.
Purpose of the Study:
- To report the outcomes and complications of percutaneous balloon dilation for stenotic right ventricle to pulmonary artery conduits and obstructed right atrium to left pulmonary artery grafts.
- To evaluate the effectiveness of balloon dilation in reducing pressure gradients and avoiding further surgical intervention.
Main Methods:
- Percutaneous balloon dilation was performed on 10 patients with stenotic right ventricle to pulmonary artery conduits and 1 patient with an obstructed right atrium to left pulmonary artery graft.
- Pressure gradients and right ventricular pressures were measured before and after dilation.
Main Results:
- Successful dilation was achieved in 9 of 10 patients with right ventricle to pulmonary artery conduits, significantly reducing conduit valve gradient, right ventricle to pulmonary artery gradient, and right ventricular pressure.
- Surgery was avoided or postponed in 8 of 11 patients.
- Complications included balloon rupture with fragment loss and circumferential balloon rupture requiring retrieval.
Conclusions:
- Percutaneous balloon dilation is effective in reducing conduit obstruction but rarely eliminates it completely.
- While it can delay or avoid surgery, potential complications such as balloon rupture must be considered.
Abstract:
The results and complications of percutaneous balloon dilation involving 10 patients with a stenotic right ventricle to pulmonary artery prosthetic conduit and 1 patient with an obstructed right atrium to left pulmonary artery Dacron graft (modified Fontan) are reported. For the 10 patients (14.5 +/- 5 years) with a right ventricle to pulmonary artery conduit, the mean (+/- SD) predilation conduit valve gradient was 57 +/- 22 mm Hg, right ventricular pressure 104 +/- 21 mm Hg and right ventricle to pulmonary artery gradient 75 +/- 23 mm Hg; 2 of the patients had additional pulmonary artery stenosis requiring dilation. In one patient, the balloon could not be advanced across the conduit valve. In 9 of 10 patients in whom dilation was successfully performed, the conduit valve gradient decreased by 59 +/- 13%, right ventricle to pulmonary artery gradient by 43 +/- 22% and right ventricular pressure by 31 +/- 11%. After dilation, right ventricular pressure was less than 65% of systemic pressure in seven patients, although no pressure was less than 40%. In 8 of the 11 patients, surgery was avoided or postponed. Complications included loss of a balloon fragment after rupture during the unsuccessful dilation of the right atrium to left pulmonary artery graft and circumferential balloon rupture requiring catheter retrieval of the distal portion of the balloon from the femoral vein after successful dilation of the right ventricle to pulmonary artery conduit. Conduit valve dilation by balloon can reduce but rarely eliminate conduit obstruction, and balloon rupture may occur and can result in fragment loss or embolization.