A ruptured balloon after successful stent implantation

1Jinyoung Song,2Eun-Young Choi, 2Sang Yoon Lee, 2Woo Seup Shimg g p

1Department of pediatrics, Samsung Medical Center 2 f di i j l i l2Department of pediatrics, Sejong General Hospital

• 11 yr old girl• CATCH 22 syndrome

30 kg/131 cm• 30 kg/131 cm• Mild degree of DOE but aggravated g gg

recently• Gr 3 SM and Gr 1 2 DM• Gr 3 SM and Gr 1-2 DM

• Initial diagnosis pulmonary atresia and VSD with MAPCA Existing MPA stump with communication

• History of Operation y p– Rt modified BT shunt and rt MAPCA ligation

(9mo of age) g– Lt unifocalization (1yr and 2mo of age)– Rastelli operation with 16mm valved conduit p

(2yr and 9mo of age)

echocardiogram

• PFO bidirectional • TR mild

Mild AR• Mild AR • Severe PS dP= 58mmHgg• Severe PR

G d b th l t i• Good both pulmonary arteries• Good LV function

• RV/Ao 79/91 mmHg

• MPA 38/16/26 mmHg

• dP : 41 mmHgg• Pr(RV/Ao) : 0.87

BAP of conduit with Z-med II 14mm-30mm

IneffectiveIneffective

Implantation of Stent Graft, [12mm, 38mm] (mount on MAXI balloon- 6atm)Re- Balloon dilataion of graft stent with MAXI [14mm, 40mm, 8atm] -complication : balloon rupturecomplication : balloon rupture

Hemodynamic results before and after the procedure

• RV/Ao79/91 mmHg ⇒ 56/93 mmHgMPA• MPA 38/16/26 ⇒ 35/13/21 mmHgg

dP 41 21 H• dP : 41 ⇒ 21mmHg• Pr (RV/Ao) : 0.87 ⇒ 0.6( / )

• The balloon catheter could not pass out via

i h hvein sheath.

• Balloon catheter was pulled out forcefully

h h hwith sheath.

• The balloon catheter broke into two pieces.

Putting 10 F sheath in left femoral vein and snaring the wire

Pushed the distal segment along with a wire into left sheath – no ruptured segment was found in the sheath

Re-snaring the wire through the same right femoral vein and then successful retrieval

In the next happening

• Keep the wire from the beginning to the• Keep the wire from the beginning to the end of the process

: the most important thing

• Snaring the ruptured balloon itself after wire snaring through contralateral femoralwire snaring through contralateral femoral vein