Author + information
- Received April 22, 2018
- Revision received May 7, 2018
- Accepted May 15, 2018
- Published online August 1, 2018.
- Fuquan Luo, MDa,
- Tao Wang, MD, PhDb,
- Jian Wang, MD, PhDb,
- Chunli Liu, MD, PhDb (, )
- Nuofu Zhang, MDb,
- Xingni Wang, MDb,
- Wenju Lu, PhDb,
- Shiyue Li, MD, PhDb and
- Cheng Hong, MD, PhDb,∗ ()
- aDivision of Cardiovascular Medicine, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- bGungzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- ↵∗Address for correspondence:
Dr. Cheng Hong OR Dr. Chunli Liu, Gungzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong 510120, China.
A 40-year-old man was admitted with symptomatic pulmonary stenosis in Takayasu arteritis. Computed tomographic pulmonary angiography demonstrated no blood flow in the left lung and a severe narrowing in the right main pulmonary artery (Figure 1). Pulmonary angiography showed reduced perfusion in the right lung (Figure 2A). Balloon pulmonary angioplasty (BPA) was attempted in the right pulmonary artery, but BPA was ceased because the patient had a seizure during balloon dilation. We suspect that the seizure was triggered by transient loss of blood flow in the brain during balloon dilation, which blocked the only pulmonary artery that connected the right heart and the lungs. To maintain pulmonary blood flow during balloon angioplasty, a 6-F long introducer sheath was advanced to the right pulmonary artery and successfully crossed the lesion to deliver blood, which was collected from the patient’s atria and anticoagulated with heparin before BPA. The blood was then injected using syringes at a speed of about 10 ml/s during balloon dilation (Figure 2B); this technique successfully prevented seizure. After balloon dilation, the narrowing of the right pulmonary artery was reduced (Figure 2C), and the blood pressure in the pulmonary artery trunk decreased from 96/12 to 68/10 mm Hg. One-week follow-up after BPA indicated that New York Heart Association functional class had improved from IV to II.
It has been previously described that BPA is safe and effective for patients with pulmonary artery stenosis caused by Takayasu arteritis (1–3). This case is unique in demonstrating that BPA in the major pulmonary artery may transiently block blood circulation and induce ischemic complications such as seizure. Using a catheter to deliver blood advanced to the lesion is an effective way to maintain pulmonary circulation and thus prevent ischemic complications.
The authors thank Dr. Yingyun Fu, Shenzhen People’s Hospital, for follow-up of the patient reported.
This work was supported by grants from the National Natural Science Foundation of China (81700426 to Dr. T. Wang) and the Young Scholar Foundation of the State Key Laboratory of Respiratory Disease (SKLRD-QN-201707 to Dr. C. Hong and SKLRD-QN-201714 to Dr. T. Wang).
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Luo, T. Wang, and J. Wang contributed equally to this article.
- Received April 22, 2018.
- Revision received May 7, 2018.
- Accepted May 15, 2018.
- 2018 American College of Cardiology Foundation
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