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

Ostovan MA, Kamali M, Zolghadrasli A - J Cardiovasc Thorac Res (2015)

Bottom Line: 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.This presentation inour patient should prompt clinicians to consider a more aggressive approach at the first sight ofthis previously considered innocent complication.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

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.

No MeSH data available.


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Mentions: The patient was observed a few hours in the recovery room and was then transferred to the ward. After a few hours the patient gradually developed dyspnea and decreased oxygen saturation. 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 lung fields and a harsh systolic murmur best heard in pulmonic area. Her blood gas analysis demonstrated mixed respiratory and metabolic acidosis and significant hypoxia and desaturation. A repeat echocardiography revealed trans-pulmonary valve gradient of 45 mm Hg associated with mild regurgitation without any other new findings. 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). In ICU she was ventilated with assist control mode with a rate of 12/min, tidal volume of 500 mL, partial oxygen fraction of 100% and PEEP of 5 mm Hg. Her 24-hour fluid intake was restricted to 1500 mL and she was given intravenous furosemide. Despite initial increase in arterial oxygen saturation, her condition remained critical with further deterioration in hemodynamics with decreased systolic blood pressure to 80 mm Hg and increased heart rate to 145/min. Her ICU course was further complicated by ventilator associated pneumothorax which was managed with chest tube insertion. Unfortunately despite all efforts, she died less than 3 days after being transferred to ICU due to shock state and severe oxygen desaturation.


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

Ostovan MA, Kamali M, Zolghadrasli A - J Cardiovasc Thorac Res (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492184&req=5

Mentions: The patient was observed a few hours in the recovery room and was then transferred to the ward. After a few hours the patient gradually developed dyspnea and decreased oxygen saturation. 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 lung fields and a harsh systolic murmur best heard in pulmonic area. Her blood gas analysis demonstrated mixed respiratory and metabolic acidosis and significant hypoxia and desaturation. A repeat echocardiography revealed trans-pulmonary valve gradient of 45 mm Hg associated with mild regurgitation without any other new findings. 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). In ICU she was ventilated with assist control mode with a rate of 12/min, tidal volume of 500 mL, partial oxygen fraction of 100% and PEEP of 5 mm Hg. Her 24-hour fluid intake was restricted to 1500 mL and she was given intravenous furosemide. Despite initial increase in arterial oxygen saturation, her condition remained critical with further deterioration in hemodynamics with decreased systolic blood pressure to 80 mm Hg and increased heart rate to 145/min. Her ICU course was further complicated by ventilator associated pneumothorax which was managed with chest tube insertion. Unfortunately despite all efforts, she died less than 3 days after being transferred to ICU due to shock state and severe oxygen desaturation.

Bottom Line: 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.This presentation inour patient should prompt clinicians to consider a more aggressive approach at the first sight ofthis previously considered innocent complication.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

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.

No MeSH data available.


Related in: MedlinePlus