a ruptured balloon after successful stent implantation · 2012. 5. 18. · a ruptured balloon after...
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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