Caveats of balloon dilation of conduits and conduit valves

Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota 55905.

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.

This article has been cited by other articles:

				S. Aggarwal, S. Garekar, T. J. Forbes, and D. R. Turner Is Stent Placement Effective for Palliation of Right Ventricle to Pulmonary Artery Conduit Stenosis? J. Am. Coll. Cardiol., January 30, 2007; 49(4): 480 - 484. [Abstract] [Full Text] [PDF]

				L. Coats, S. Khambadkone, G. Derrick, S. Sridharan, S. Schievano, B. Mist, R. Jones, J. E. Deanfield, D. Pellerin, P. Bonhoeffer, et al. Physiological and Clinical Consequences of Relief of Right Ventricular Outflow Tract Obstruction Late After Repair of Congenital Heart Defects Circulation, May 2, 2006; 113(17): 2037 - 2044. [Abstract] [Full Text] [PDF]

				C. A. C. Pedra, H. Justino, D. G. Nykanen, G. V. MD, J. G. Coles, W. G. Williams, R. M. Freedom, and L. N. Benson Percutaneous stent implantation to stenotic bioprosthetic valves in the pulmonary position J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 82 - 87. [Abstract] [Full Text] [PDF]

				D. B. McElhinney, V. M. Reddy, P. Moore, M. M. Brook, and F. L. Hanley Surgical intervention for complications of transcatheter dilation procedures in congenital heart disease Ann. Thorac. Surg., March 1, 2000; 69(3): 858 - 864. [Abstract] [Full Text] [PDF]

				J. M. Williams, M. de Leeuw, M. D. Black, R. M. Freedom, W. G. Williams, and B. W. McCrindle Factors associated with outcomes of persistent truncus arteriosus J. Am. Coll. Cardiol., August 1, 1999; 34(2): 545 - 553. [Abstract] [Full Text] [PDF]

				H. D. Allen, R. H. Beekman III, A. Garson Jr, Z. M. Hijazi, C. Mullins, M. P. O'Laughlin, and K. A. Taubert Pediatric Therapeutic Cardiac Catheterization : A Statement for Healthcare Professionals From the Council on Cardiovascular Disease in the Young, American Heart Association Circulation, February 17, 1998; 97(6): 609 - 625. [Full Text] [PDF]

				A. J. Powell, J. E. Lock, J. F. Keane, and S. B. Perry Prolongation of RV-PA Conduit Life Span by Percutaneous Stent Implantation : Intermediate-Term Results Circulation, December 1, 1995; 92(11): 3282 - 3288. [Abstract] [Full Text]