Abstract
Three children, in whom seven pulmonary arteries (PA)had been balloon dilated, were evaluated at autopsy. Ages at dilation were 2½, 2½, and 8 years. The dilating balloon was three to four times the diameter of the undilated PA. Dilating pressure was7-9 atmospheres. In five PA, angiographically measured predilation diameter averaged 2.6mm(2-2.9mm) and post dilation diameter averaged 6mm (5.5-6.6mm).
In two PA,balloon dilation had occurred zero and three days prior. Each PA revealed a long,linear,medial tear. Microscopy revealed transmedial rupture and hemorrhage into the media and adventitia of both.
The other five PA were evaluated 4-14 months post-dilation. Each PA had a long,linear,healed, medial tear. Microscopy revealed prior transmedial rupture in all 5 PA.Healing occurred by reconstitution of media to approximately normal thickness in 4 of 5. This neo media was composed of disrupted and noncircumferential elastic tissue fibres interspersed with collagen. In one PA, 14 months post dilation, the media at the rupture site was only lmm thick. Increased collagen and elastic fibre deposition was present in the adventitia in all five and also in the intima in two. These healing processes did not compromise PA diameter. Transmedial rupture was the major mechanism of diameter increase in all 7 PA. In six the adventitia maintained PA integrity. One PA ruptured during balloon dilation.
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Lucas, R., Lock, J., Edwards, B. et al. “ANATOMIC SEQUELAE OF BALLOON ANGIOPLASTY OF PULMONARY ARTERIES IN CHILDREN”. Pediatr Res 18 (Suppl 4), 126 (1984). https://doi.org/10.1203/00006450-198404001-00201
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DOI: https://doi.org/10.1203/00006450-198404001-00201