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A male infant underwent successful dilatation of supravalvar pulmonary stenosis at which time additional multiple peripheral pulmonary artery stenoses were identified. Three separate attempts were made to dilate these using balloon inflation pressures up to 20 atmospheres. Many lesions resisted inflation and right ventricular pressure remained suprasystemic. At 2.5 years old these stenoses were dilated using a 3.75 mm cutting balloon system followed by a 4 mm coronary high pressure balloon. The left figure is a selective angiogram within the left pulmonary artery showing a tight stenosis. The right figure is the final angiogram. After dilatation of several resistant stenoses the right ventricular pressure fell from 115 to 60 mm Hg.
The cutting balloon system consists of an angioplasty balloon with four longitudinally mounted microsurgical blades at 90° angles, which deploy when the balloon is inflated. The inflated diameters of the balloons range from 2 to 4 mm (0.25 mm increments) and the balloon lengths range from 10 to 15 mm. The working height of the atherotomes is from 0.127 to 0.152 mm. This system has been described in the management of resistant coronary lesions1 and demonstrated in an animal model of peripheral pulmonary stenoses.2 To our knowledge this is the first description of the use of a cutting balloon for this application in a child.