A novel method to prevent recurrent balloon rupture during dilation of heavily calcified conduits in preparation for transcatheter pulmonary valve placement

Anas Abu Hazeem; Osamah Aldoss; Thomas Fagan

doi:10.1002/ccd.26054

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A novel method to prevent recurrent balloon rupture during dilation of heavily calcified conduits in preparation for transcatheter pulmonary valve placement

Journal article

Peer reviewed

A novel method to prevent recurrent balloon rupture during dilation of heavily calcified conduits in preparation for transcatheter pulmonary valve placement

Anas Abu Hazeem, Osamah Aldoss and Thomas Fagan

Catheterization and cardiovascular interventions, Vol.87(3), pp.421-425

02/15/2016

DOI: 10.1002/ccd.26054

PMID: 26308663

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Abstract

A 24-year-old female presented for percutaneous pulmonary valve placement. She was born with tetralogy of Fallot and had initial palliation with a Blalock-Taussig shunt followed by complete repair at age of 4 years including placement of a homograft conduit in the right ventricle to pulmonary artery position. She had developed severe obstruction in the conduit. Angiography showed a heavily calcified conduit with moderate insufficiency. During pre-dilation, a total of six balloons ruptured due to heavy conduit calcification prior to reaching desired inflation diameter. Subsequently, double balloon technique was attempted using two 9-mm Conquest balloons. One of the conquest balloons was then replaced by 16-mm Atlas balloon and conduit dilation was performed. At full inflation, the Conquest balloon ruptured. The deflated ruptured Conquest balloon was kept in the conduit and the Atlas balloon was exchanged for 18 and then 20-mm Atlas balloons and both were used to dilate the conduit. The deflated ruptured Conquest balloon protected the Atlas balloons and conduit angioplasty proceeded successfully without further rupture of any balloon. Subsequently, four stents were placed in the conduit followed by delivery of Melody Valve using a 20-mm Ensemble system with excellent results. This case illustrates a novel method of using the body of a ruptured balloon to protect subsequent balloons from rupture due to heavy conduit calcification. This method requires the presence of two venous access lines but might save time, effort, and cost from repeated balloon ruptures.

Heart Valve Prosthesis Implantation - instrumentation

Radiography, Interventional

Graft Occlusion, Vascular - diagnostic imaging

Pulmonary Valve - diagnostic imaging

Humans

Graft Occlusion, Vascular - therapy

Vascular Calcification - diagnostic imaging

Fontan Procedure - adverse effects

Pulmonary Artery - diagnostic imaging

Pulmonary Artery - surgery

Angioplasty, Balloon - adverse effects

Equipment Design

Young Adult

Blood Vessel Prosthesis Implantation - adverse effects

Vascular Calcification - etiology

Tetralogy of Fallot - diagnosis

Female

Stents

Pulmonary Valve - physiopathology

Blood Vessel Prosthesis Implantation - instrumentation

Heart Valve Prosthesis

Heart Valve Prosthesis Implantation - methods

Treatment Outcome

Pulmonary Artery - physiopathology

Angioplasty, Balloon - instrumentation

Cardiac Catheterization - instrumentation

Graft Occlusion, Vascular - etiology

Tetralogy of Fallot - surgery

Blalock-Taussig Procedure

Vascular Access Devices

Vascular Calcification - therapy

Equipment Failure

Details

Title: Subtitle: A novel method to prevent recurrent balloon rupture during dilation of heavily calcified conduits in preparation for transcatheter pulmonary valve placement
Creators: Anas Abu Hazeem - Division of Pediatric Cardiology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
Osamah Aldoss - Department of Pediatrics, Division of Cardiology, University of Colorado Denver, Aurora, Colorado
Thomas Fagan - Department of Pediatrics, Division of Cardiology, University of Colorado Denver, Aurora, Colorado
Resource Type: Journal article
Publication Details: Catheterization and cardiovascular interventions, Vol.87(3), pp.421-425
DOI: 10.1002/ccd.26054
PMID: 26308663
ISSN: 1522-1946
eISSN: 1522-726X
Language: English
Date published: 02/15/2016
Academic Unit: Stead Family Department of Pediatrics
Record Identifier: 9984093373902771

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2 Times Cited - Web of Science