Author + information
- Received October 27, 2014
- Accepted November 6, 2014
- Published online April 27, 2015.
- ∗Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
- †Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
- ↵∗Reprint requests and correspondence:
Dr. Hiromi Matsubara, Departments of Cardiology and Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan.
A 76-year-old male patient with inoperable chronic thromboembolic pulmonary hypertension was referred to our hospital for treatment with balloon pulmonary angioplasty (BPA). He was in World Health Organization functional class III and pulmonary artery pressure was 69/6 (34) mm Hg. We performed BPA in a staged fashion and at the fourth BPA session, we targeted the left upper lobe A1+2. Pulmonary angiography showed the ring-like stenotic lesion (arrowhead in Figure 1A), and we evaluated the lumen size of the vessel with intravascular ultrasound. We then expanded the vessel with a balloon (5.0 × 20 mm; Bandicoot RX, Kaneka Medix, Osaka, Japan) (Figure 1B). However, immediately after deflation of the balloon, severe hemosputum occurred. Pulmonary angiography showed extravasation of contrast medium (Figure 1C, Online Video 1). We recognized that a pulmonary artery rupture had occurred and tried to stop the bleeding by balloon occlusion. However, we failed and deployed a covered stent of 3.0 × 16 mm (JOSTENT GraftMaster, Abbott Vascular, Santa Clara, California) to the rupture site. We inflated the balloon (5.0 × 20 mm) inside the stent, and pulmonary angiography showed the disappearance of extravasation of contrast medium (Figure 1D, Online Video 2). Repeated pulmonary angiography 2 weeks later revealed no extravasation. In-stent restenosis does not occur for 2 years (Figures 1E and 1F, Online Video 3).
Although pulmonary artery rupture is a rare complication during BPA, it can cause lethal bleeding. Therefore, it is essential for operators of BPA to know how to handle this complication. The efficacy of coil embolization for pulmonary artery rupture was reported (1,2); however, the embolized vessel could never be reperfused. Treatment with a covered stent could maintain the perfusion of the treated artery. Although the utility of a covered stent for pulmonary artery stenosis and aneurysm has been reported (3,4), this is the first report to describe the management of pulmonary artery rupture by a covered stent.
For supplemental videos and their legends, please see the online version of this article.
Drs. Ogawa and Matsubara have received lecturer fees from GlaxoSmithKline, Actelion Pharmaceuticals Japan, and Nippon Shinyaku. Dr. Ejiri has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2014.
- Accepted November 6, 2014.
- American College of Cardiology Foundation