Non-deflating balloon during pulmonary valvuloplasty

A 3-year-old, 4.8 kg, male intact, mixed breed dog was referred for balloon pulmonary valvuloplasty (BPV). Echocardiography was consistent with severe type A pulmonic stenosis and BPV was recommended. During BPV, the balloon catheter failed to deflate despite multiple attempts at repositioning and the use of different deflation syringes. After approximately two minutes of cardiopulmonary arrest, forceful retrograde traction resulted in removal of the fully inflated balloon. Cardiopulmonary resuscitation was unsuccessful. Post-mortem evaluation by a board-certified pathologist identified rupture of the cranial vena cava and hemothorax, suspected to be secondary to forceful removal of the fully inflated balloon. Manufacturer's evaluation of the balloon catheter used in the procedure identified multiple kinks and a segment of stretched catheter shaft suspected to be the cause for the inability to deflate. A manufacturing defect present prior to use or predisposing to stretching of the catheter segment could not be ruled out. Kinking and/or stretching of the catheter during BPV were possible causes as well. Although the inability to deflate a balloon catheter seems to be a very rare occurrence, it should be considered as a potential complication of BPV.