title: The development of a pseudo-chamber after balloon pulmonary angioplasty: long-term complications of balloon pulmonary angioplasty.
abstract: We experienced a rare complication where extravasation developed a pseudo-chamber long after the balloon pulmonary angioplasty for supravalvular pulmonary stenosis. A 3-month-old girl was diagnosed with an anomalous origin of the left coronary artery from the pulmonary artery. She underwent the Takeuchi procedure at 10 months of age. During the follow-up, the supravalvular pulmonary stenosis deteriorated, and was treated by balloon pulmonary angioplasty with the double balloon technique catheter at 6 years of age. Angiography at the main pulmonary artery showed a small amount of extravasation contrast medium after the procedure. Follow-up echocardiography showed a diminished extravasation hemorrhage. Twelve years later, right ventricular enlargement due to pulmonary regurgitation had been observed on echocardiography. In addition, abnormal echo free space was detected at the left posterior of the left atrium. Enhanced computed tomography clearly demonstrated there was an orifice and extent of the pseudo-chamber. Surgical findings revealed a large tear just distal to the coronary tunnel. We speculated that extravasation blood was limited in the perivascular area early after the procedure but eventually reached the non-adhesive oblique pericardial sinus with age. Consequently, pulmonary to oblique pericardial sinus communication was established and looked like a pseudo-chamber long after the procedure. In conclusion, even if extravasation seems to be limited immediately after the balloon pulmonary angioplasty, it could expand for non-adhesive space and could develop a huge blood space like chamber. Long-term careful observation should be necessary for extravasation of pulmonary artery even with surgical adhesion.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan. psugiyama@hij.twmu.ac.jp.|Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan. psugiyama@hij.twmu.ac.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugiyama
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kise
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Toda
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Hoshiai
mesh_terms: D000293:Adolescent; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D018450:Disease Progression; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Balloon pulmonary angioplasty; Pseudo-chamber; Supra valvular pulmonary stenosis