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Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management

Charles M. Baker, MD^a, Francis X. McGowan, Jr., MD, John F. Keane, MD, FACC^a and James E. Lock, MD, FACC^a

^a Cardiology, The Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Anesthesiology, The Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

View larger version (120K): [in a new window]   Figure 1 Confined tear: an anterior/posterior projection frame after angiography that followed balloon dilation of the proximal left pulmonary artery. The arrow indicates an area of extravascular contrast that was not progressive. The guide wire is seen passing antegrade through the right heart into the left pulmonary artery.

View larger version (95K): [in a new window]   Figure 2 Unconfined tear: (A) An anterior/posterior frame from an angiogram demonstrating a large tear (black arrows) in the left pulmonary artery after balloon dilation. Free flow of contrast into the pleural space can be seen (white arrow). (B) The same pulmonary artery after coil occlusion (arrow) of the tear, demonstrating no further extravasation of contrast.

View larger version (17K): [in a new window]   Figure 3 Catheter interventions: the above is a summary of the outcome of patients who sustained pulmonary artery tears and had interventions in the catheterization lab to address the tear. The patient who had a stent placed was acutely treated with extracorporeal membrane oxygenation (ECMO).

View larger version (31K): [in a new window]   Figure 4 Incidence of tears: the above bar graph illustrates the incidence of pulmonary artery tears and deaths due to such tears per 100 catheterizations involving balloon dilation of pulmonary arteries. The use of coils to treat such tears was introduced in 1992.