Page 34 - Journal of Structural Heart Disease Volume 4, Issue 5

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Case Report
Figure 1. Partially inflated balloon within LPA stent. The 7mm x 2cm Sterling Balloon has been inflated within the LPA stent, but cannot be fully deflated.
ough, MA) was positioned from the RIJ sheath into the distal LPA across the LPA stent. The initial short RIJ sheath was exchanged for a 63 cm long 4 Fr sheath (Cook Medical, Bloomington, IN), positioned across the LPA stent. A 7mm x 2cm Sterling Balloon (Boston Scientific Corporation, Marlborough, MA) was ad- vanced through the long sheath, over the wire and positioned within the LPA stent. The balloon was in- flated several times until it was positioned well with- in the stent. After the balloon was inflated a fourth time, however, the balloon catheter could not be fully deflated and could not be housed in the 4 Fr sheath (Figure 1). Of note, we had previously resheathed the balloon by using an inflate-deflate method involving applying positive and then negative pressure to the balloon while pulling the balloon into the sheath to keep the sheath in the pulmonary artery.
Because the balloon could not be resheathed, the sheath, balloon and Platinum Plus wire were all pulled into the right atrium to straighten the curve. Negative pressure was applied many times to the bal- loon with no success in deflation. The 6 Fr sheath in
Figure 2. Balloon partially pulled into sheath. The partially de- flated balloon has been snared and mostly pulled into the 8 Fr sheath with a portion of the balloon exposed in right atrium. Note that the width of the balloon is similar to the width of the 8 Fr sheath.
the LFV was exchanged for an 8 Fr 90cm long sheath in an attempt to snare and cover the deflated balloon. The distal tip of the Platinum Plus wire was snared in the right atrium through this 8 Fr sheath and the bal- loon was pulled into this larger sheath. Unfortunately, the balloon could not be completely pulled into the 8 Fr sheath, but the profile of the balloon extruding from the sheath was nearly the same width as the 8 Fr sheath (Figure 2). The 8 Fr sheath, snare, balloon, Platinum Plus wire and 4 Fr sheath were then pulled down and out of the left groin with part of the bal- loon uncovered by the sheath (Figure 3). The partially inflated balloon was exposed and punctured with a needle and deflated manually. It could then be pulled back into the 4 Fr RIJ long sheath and safely removed (Figure 4).
Discussion
The inability to deflate an angioplasty balloon is a known, albeit uncommon, complication of balloon dilation procedures [1]. This complication was first
Nageotte S. et al.
Retrieval of a Partially Deflated Balloon