Entrapment of a Balloon Catheter during Stent Implantation for Vertical Venous Stenosis in Two Neonates with Single Ventricle and Total Anomalous Pulmonary Venous Connection

Abstract

To avoid surgical interventions in the management of neonates with single ventricle and total anomalous pulmonary venous return, stenting in the narrowing vertical vein can be performed. We report two cases of balloon entrapment during stenting in such procedures. (Case 1) A 3.5-kg boy born at 40 weeks’ gestation was diagnosed with single ventricle, pulmonary stenosis, and supracardiac total anomalous pulmonary venous return. He developed pulmonary congestion, visible on chest X-ray, due to the narrowing vertical vein draining into the left superior caval vein. Soon after birth, we performed stenting (using Express SD^® 6 mm) in the vertical vein with a left jugular vein approach. However, the balloon became entrapped in the stent with a waist after deflation. (Case 2) A 2.8-kg girl born at 39 weeks’ gestation was diagnosed with hypoplastic left heart syndrome and supracardiac total anomalous pulmonary venous return. We performed stenting (using Express SD^® 8 mm) in the vertical vein on the day after birth, approaching from the right jugular vein. However, the balloon was entrapped in the stent with a waist and we had difficulty withdrawing the balloon catheter. In both cases, the balloon catheters were able to be withdrawn by manipulation of the sheath and catheter. Balloon entrapment should be acknowledged as a possible serious complication of stenting in the non-compliant vertical vein in neonates with total anomalous pulmonary venous return.