Dissecting Aneurysm of the Main Pulmonary Artery

Since the first introduction of pulmonary balloon valvuloplasty by Kan in 1982, the procedure has been used for relief of pulmonary valve stenosis. It is normally recommended that the procedure should be performed for peak-to-peak gradients in excess of 50 mm Hg,1 and the balloon/annulus ratio should be 1.2 to 1.25 for effective and safe results.2 Complications of the procedure are minimal and rare. We present the case of dissecting aneurysm of the main pulmonary artery, a dangerous complication of pulmonary balloon valvuloplasty performed in a child, which was successfully treated with surgical management.A 4-year-old boy was admitted to our hospital in December, 2007, whose history included 2 years of 4/6 systolic murmur heard over the pulmonary artery. The transthoracic echocardiogram showed severe pulmonary valve stenosis, and the Doppler-measured peak instantaneous gradient was 121 mm Hg, which was the indication for pulmonary balloon valvuloplasty. A 6F Mansfield balloon catheter was used (18/30 mm, balloon-to-annulus ratio 1.15). The catheterization-measured peak-to-peak gradient was 125 mm Hg. Manual inflation was performed until the balloon indentation disappeared, and 2 additional inflations were performed. After the inflations, the transvalvular pressure gradient was reduced to 28 mm Hg. The patient was observed in an …