| Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management. | |
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MedLine Citation:
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PMID: 11079677 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We reviewed the management and outcome of patients experiencing pulmonary artery (PA) trauma during balloon dilation (BD). BACKGROUND: Balloon dilation of the PA is important in the management of peripheral pulmonary stenosis. Successful BD requires a controlled tear of the PA; excessive tearing can produce complications ranging from pseudoaneurysms to rupture and death. The incidence and optimum management for such complications are unreported. METHODS: All records of patients who underwent branch PA dilation between June 1984 and October 1997 were reviewed; those with a significant complication were analyzed. RESULTS: Of 1,286 catheterizations in 782 patients, PA trauma (excluding isolated pulmonary edema and PA aneurysms) was identified in 29 catheterizations in 26 patients. Tears occurred distal to the area of stenosis in most cases (62%). Intensive medical management, with and without catheter directed therapy, was employed. The damaged PA was successfully coil embolized in five patients, four of whom survived; temporary balloon occlusion did not prevent death in two patients. There were six deaths from pulmonary hemorrhage. A case control analysis demonstrated that PA trauma was significantly associated with pulmonary hypertension. CONCLUSIONS: Pulmonary artery trauma associated with BD occurs mostly distal to the site of narrowing, is associated with underlying pulmonary hypertension and is frequently (5/12 or 42%) fatal in those with unconfined tears. Intensive management strategies as well as attention to distal balloon position may reduce incidence and mortality. Coil occlusion of the damaged PA appears to be a valuable strategy to prevent fatal hemorrhage. |
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Authors:
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C M Baker; F X McGowan; J F Keane; J E Lock |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 36 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2000 Nov |
Date Detail:
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Created Date: 2001-01-02 Completed Date: 2001-01-02 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1684-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Arterial Occlusive Diseases / therapy* Balloon Dilatation / adverse effects* Child Child, Preschool Humans Infant Pulmonary Artery / injuries* Risk Factors |
| Grant Support | |
ID/Acronym/Agency:
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T-32 HL07572/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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