Coronary Compression Following Percutaneous Pulmonary Valve Implantation Despite a Negative Balloon Sizing Test: Lessons Learnt From This Unusual Complication

• Published in: Cardiovascular revascularization medicine 2022-07, Vol.40, p.135-138
• Main Authors: Velázquez Martín, Maite, Sarnago Cebada, Fernando, Maneiro Melón, Nicolás, Herrera Linde, Lola, Flores Fernández, Marta, Mendoza Soto, Alberto
• Format: Article
• Language: English
• Subjects: Balloon sizing test; Coronary compression; Percutaneous pulmonary valve implant
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2021.08.001

A 16-years-old male with prior diagnosis of situs inversus totalis and pulmonary atresia with interventricular communication underwent percutaneous pulmonary valve implantation 3 months after successful RVOT stenting following a negative balloon sizing test. Once finished the procedure, after consciousness recovery in the intensive care unit, the patient developed oppressive chest pain with very subtle electrocardiographic changes over his basal right bundle branch block. An urgent coronary angiography showed a severe stenosis in the proximal right coronary artery with TIMI 2 distal flow. Intravascular ultrasound imaging confirmed extrinsic compression. A 4 × 21 mm drug-eluting stent was successfully implanted relieving symptoms immediately. TIMI 3 flow was restored and good apposition and expansion were confirmed with intravascular ultrasound. A carefully review of the procedure showed that the pitfall responsible for this complication was the oversizing of the valve with respect to the size of the balloon used for the sizing test. •Appropriate balloon sizing during right ventricular outflow tract interrogation is crucial for test interpretation.•Coronary compression can happen after pulmonary valve implant though a negative balloon test.•Mild ECG changes and chest pain after pulmonary valve implant can mean coronary compression•The threshold for coronary angiography after pulmonary valve implant must be low.