Author + information
- Received January 24, 2014
- Revision received February 18, 2014
- Accepted February 26, 2014
- Published online September 1, 2014.
- Alban-Elouen Baruteau, MD∗ (, )
- Jérôme Petit, MD,
- Philippe Brenot, MD,
- Jean-Yves Riou, MD and
- Claude-Yves Angel, MD
- Marie Lannelongue Hospital–M3C, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Le Kremlin Bicêtre, Paris, France
- ↵∗Reprint requests and correspondence:
Dr. Alban-Elouen Baruteau, Département de Chirurgie des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France.
- cardiac arrest
- cardiac catheterization
- myocardial infarction
- Ross procedure
- transcatheter pulmonary valve implantation
A 34-year-old woman was referred for transcatheter pulmonary valve implantation. She had been exposed to radiotherapy for Hodgkin’s disease and underwent a Ross procedure 16 years before for post-endocarditis aortic regurgitation. Test-balloon angioplasty with a 22 × 20-mm Atlas balloon (Bard Peripheral Vascular, Tempe, Arizona) inflated to 14 atm, showed no coronary compression (Figure 1A, Online Video 1). Pre-stenting of the right ventricular outflow tract with a 36-mm Intrastent LD-Max (EV3, Plymouth, Minnesota) mounted on a 22 × 45-mm BIB balloon-in-balloon catheter (Numed, Hopkinton, New York) was uneventful, and a second aortography showed no coronary compression (Figure 1B). A 23-mm Edwards SAPIEN pulmonic valve (Edwards Lifesciences, Irvine, California) was implanted, followed by intractable ventricular fibrillation that was due to left anterior descending coronary artery occlusion (Figure 1C, Online Video 2). Extrinsic compression was attributed to a mediastinal tissue block displacement during valve implantation. Under chest compressions, rescue percutaneous coronary revascularization was performed (Figures 1D and 1E, Online Video 3) with implantation of a bare-metal stent in the proximal left anterior descending artery. After 2 years of follow-up, the patient is alive, and her coronary angiography is normal. Coronary artery compression may be observed in 5% of patients during test-balloon angioplasty (1). This complication is associated with abnormal coronary anatomy, especially in patients with tetralogy of Fallot or transposition of the great arteries (1). According to our exceptional case, caution should also be applied in patients with a radiated chest, even with normal coronary anatomy and normal test-balloon angioplasty.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 24, 2014.
- Revision received February 18, 2014.
- Accepted February 26, 2014.
- American College of Cardiology Foundation