A Case of Fatal Acute Lung Injury after Balloon Valvuloplasty of Pulmonary Stenosis: Case Report and Review of Literature.

Mohammad Ali Ostovan,Maliheh Kamali,Abdolali Zolghadrasli

doi:10.15171/jcvtr.2015.18

Abstract

A newly described immediate complication after percutaneous pulmonary valvuloplasty isacute lung injury. Here we report a case of fatal acute lung injury after pulmonary valvuloplasty.The patient was a 26-year-old woman, referred to a general hospital with the diagnosis of livercirrhosis. In her work-ups severe pulmonary stenosis was detected and so a decision was madeto relieve the valve stenosis. Despite the procedural success, the patient developed severe dyspneaand desaturation a few hours later and died within 3 days due to shock state. Although thedefinition, incidence or severity of acute lung injury after pulmonary balloon valvuloplasty is notyet clear, this is as far as we know the first mortality reported in literature. This presentation inour patient should prompt clinicians to consider a more aggressive approach at the first sight ofthis previously considered innocent complication.

Highlights

Despite the recent advances in technical success of this procedure, newer complications are coming into light.[1,3,6,8]. One such is acute lung injury in the first few hours after balloon valvuloplasty.[4,9]. This complication is reported to be common and usually mild, here we report a case of acute lung injury after balloon valvuloplasty which led to mortality in a 26 years old female adult.[10]
The patient’s cirrhosis was attributed to pulmonary stenosis and because of favorable valvular morphology, percutaneous transvalvular pulmonary valvuloplasty was scheduled for the patient
Acute Lung Injury After Pulmonary Valvuloplasty lung fields and a harsh systolic murmur best heard in pulmonic area

Summary

Introduction

Pulmonary valve stenosis is one of the most common forms of congenital heart diseases in the adults comprising about 5%-10% of all cases.[1,2,3] Since its introduction in 1982, balloon valvuloplasty has become the method of choice to alleviate symptoms and improve pressure gradient across stenotic pulmonary valves.[1,3,4,5,6,7] Despite the recent advances in technical success of this procedure, newer complications are coming into light.[1,3,6,8] One such is acute lung injury in the first few hours after balloon valvuloplasty.[4,9] this complication is reported to be common and usually mild, here we report a case of acute lung injury after balloon valvuloplasty which led to mortality in a 26 years old female adult.[10]. Because of abnormal liver tests, an abdominal sonography was done which was in favor of liver cirrhosis and so she was admitted to a tertiary care center for better management On admission she had blood pressure of 110/70 mm Hg, pulse rate of 80/min, respiratory rate of 20/min, temperature of 36.5°C orally. Noninvasive oxygenation with facial mask was initiated Her examination revealed blood pressure of 100/80 mm Hg, pulse rate of 128/min, respiratory rate of 28/min, cyanotic lips, diffuse bilateral fine rales over the. Portable chest X-ray revealed bilateral diffuse haziness (Figure 2) As she was unresponsive to non-invasive oxygenation with mask, she was intubated with endotracheal tube and transferred to the intensive care unit (ICU). Despite all efforts, she died less than 3 days after being transferred to ICU due to shock state and severe oxygen desaturation

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Conclusion