ABSTRACT
Prolonged Balloon Inflation In large type II and all type III perforations, the first maneuver, even before starting cardiopulmonary resuscitation, pericardiocentesis, or reversal of anticoagulation, should be the placement of a balloon catheter (with balloon to artery diameter ratio of 0.9-1.0) at the site of perforation or upstream in case of distal perforation, inflated at a low pressure (2-6 atm). Serial angiographic assessments of the perforation should be performed at 10 to 15 minutes inflation periods. In case of incomplete perforation sealing, the use of a perfusion balloon has been recommended to reduce myocardial ischemia, but the availability of these devices in catheterization laboratories has markedly decreased (24,37,40).
