Balloon testing to evaluate safety of transcatheter pulmonary valve implantation

Angiographic images obtained during a balloon test performed prior to planned TPVI. The patient is a 7-year-old boy with an interrupted arch and ventricular septal defect who had previously undergone a Ross-Konno operation and 2 replacements of right ventricle to pulmonary artery conduits.

(Left panel) Aortogram showing contrast in the left main and right coronary arteries and a guidewire positioned in the right ventricular outflow tract. Note the relatively distal origin of the left coronary artery.

(Right panel) Aortogram during high pressure balloon inflation in the right ventricular outflow tract to the maximum final expected diameter. Note that the left coronary artery does not fill with contrast. During balloon testing, the patient experienced bradycardia with a junctional rhythm that reverted to normal sinus rhythm upon deflation of the balloon. Due to the results of this balloon test, TPVI was not performed.