Hostname: page-component-6766d58669-zlvph Total loading time: 0 Render date: 2026-05-16T17:23:00.387Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical outcomes after the endovascular treatments of pulmonary vein stenosis in patients with congenital heart disease

Published online by Cambridge University Press:  09 July 2019

Yoshihiko Kurita ,
Kenji Baba ,
Maiko Kondo ,
Takahiro Eitoku ,
Shingo Kasahara ,
Tatsuo Iwasaki ,
Shinichi Ohtsuki  and
Hirokazu Tsukahara
Yoshihiko Kurita
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Kenji Baba*
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Maiko Kondo
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Takahiro Eitoku
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Shingo Kasahara
Affiliation:
Department of Cardiovascular surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Tatsuo Iwasaki
Affiliation:
Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Shinichi Ohtsuki
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
Hirokazu Tsukahara
Affiliation:
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
*
Author for correspondence: K. Baba, MD, PhD, Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan. Tel: +81-86-235-7249; Fax: +81-86-221-4745; E-mail: kenjibaba@cc.okayama-u.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Pulmonary vein stenosis (PVS) is a condition with challenging treatment and leads to severe cardiac failure and pulmonary hypertension. Despite aggressive surgical or catheter-based intervention, the prognosis of PVS is unsatisfactory. This study aimed to assess the prognosis and to establish appropriate treatment strategies.

Methods:

We retrospectively reviewed endovascular treatments for PVS (2001–2017) from the clinical database at the Okayama University Hospital.

Results:

A total of 24 patients underwent PVS associated with total anomalous pulmonary venous connection and 7 patients underwent isolated congenital PVS. In total, 53 stenotic pulmonary veins were subjected to endovascular treatments; 40 of them were stented by hybrid (29) and percutaneous procedures (11) (bare-metal stent, n = 34; drug-eluting stent, n = 9). Stent size of hybrid stenting was larger than percutaneous stenting. Median follow-up duration from the onset of PVS was 24 months (4–134 months). Survival rate was 71 and 49% at 1 and 5 years, respectively. There was no statistically significant difference between stent placement and survival; however, patients who underwent bare-metal stent implantation had statistically better survival than those who underwent drug-eluting stent implantation or balloon angioplasty. Early onset of stenosis, timing of stenting, and small vessel diameter of pulmonary vein before stenting were considered as risk factors for in-stent restenosis. Freedom from re-intervention was 50 and 26% at 1 and 2 years.

Conclusions:

To improve survival and stent patency, implantation of large stent is important. However, re-intervention after stenting is also significant to obtain good outcome.

Keywords

Pulmonary vein stenosistotal anomalous of pulmonary venous connectionisolated congenital pulmonary vein stenosishybrid stent implantationballoon angioplastyre-intervention for stent

Information

Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1057 - 1065
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Seale, AN, Webber, SA, Uemura, H, et al. Pulmonary vein stenosis: the UK, Ireland and Sweden collaborative study. Heart 2009; 95: 1944–1949.CrossRefGoogle ScholarPubMed
Seale, AN, Uemura, H, Webber, SA, et al. Total anomalous pulmonary venous connection: outcome of postoperative pulmonary venous obstruction. J Thorac Cardiovasc Surg 2013; 145: 1255–1262.CrossRefGoogle ScholarPubMed
DiLorenzo, MP, Ashley, S, Faerber, JA, et al. Patient characteristics and mortality in children With pulmonary ein stenosis. Circulation 2018; 136: A17454.Google Scholar
Mendelsohn, AM, Bove, EL, Lupinetti, FM, et al. Intraoperative and percutaneous stenting of congenital pulmonary artery and vein stenosis. Circulation 1993; 88: Ii210–217.Google ScholarPubMed
Hancock Friesen, CL, Zurakowski, D, Thiagarajan, RR, et al. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg 2005; 79: 596–606; discussion 596-606.CrossRefGoogle Scholar
Jenkins, KJ, Sanders, SP, Orav, EJ, Coleman, EA, Mayer, JE , Jr, Colan, SD. Individual pulmonary vein size and survival in infants with totally anomalous pulmonary venous connection. J Am Coll Cardiol 1993; 22: 201–206.CrossRefGoogle ScholarPubMed
Shi, G, Zhu, Z, Chen, J, et al. Total anomalous pulmonary venous connection: the current management strategies in a pediatric cohort of 768 patients. Circulation 2017; 135: 48–58.CrossRefGoogle Scholar
Kanter, KR, Kirshbom, PM, Kogon, BE. Surgical repair of pulmonary venous stenosis: a word of caution. Ann Thorac Surg 2014; 98: 1687–1691; discussion 1691-2.CrossRefGoogle ScholarPubMed
Song, MK, Bae, EJ, Jeong, SI, et al. Clinical characteristics and prognostic factors of primary pulmonary vein stenosis or atresia in children. Ann Thorac Surg 2013; 95: 229–234.CrossRefGoogle ScholarPubMed
Fender, EA, Widmer, RJ, Hodge, DO, et al. Severe pulmonary vein stenosis resulting from ablation for atrial fibrillation: presentation, management, and clinical outcomes Circulation. 2016; 134: 1812–1821.CrossRefGoogle ScholarPubMed
Buiatti, A, von Olshausen, G, Martens, E, et al. Balloon angioplasty versus stenting for pulmonary vein stenosis after pulmonary vein isolation for atrial fibrillation: a meta-analysis. Int J Cardiol 2018; 254: 146–150.CrossRefGoogle ScholarPubMed
Prieto, LR, Schoenhagen, P, Arruda, MJ, Natale, A, Worley, SE. Comparison of stent versus balloon angioplasty for pulmonary vein stenosis complicating pulmonary vein isolation. J Cardiovasc Electrophysiol 2008; 19: 673–678.CrossRefGoogle ScholarPubMed
Kato, H, Fu, YY, Zhu, J, et al. Pulmonary vein stenosis and the pathophysiology of “upstream” pulmonary veins. J Thorac Cardiovasc Surg 2014; 148: 245–253.CrossRefGoogle ScholarPubMed
Seale, AN, Daubeney, PE, Magee, AG, Rigby, ML. Pulmonary vein stenosis: initial experience with cutting balloon angioplasty. Heart 2006; 92: 815–820.CrossRefGoogle ScholarPubMed
McMahon, CJ, McDermott, M, Walsh, KP. Failure of cutting balloon angioplasty to prevent restenosis in childhood pulmonary venous stenosis. Catheter Cardiovasc Interv 2006; 68: 763–766.CrossRefGoogle ScholarPubMed
Balasubramanian, S, Marshall, AC, Gauvreau, K, et al. Outcomes after stent implantation for the treatment of congenital and postoperative pulmonary vein stenosis in children. Circ Cardiovasc Interv 2012; 5: 109–117.CrossRefGoogle ScholarPubMed
Cory, MJ, Ooi, YK, Kelleman, MS, Vincent, RN, Kim, DW, Petit, CJ. Reintervention is associated with improved survival in pediatric patients with pulmonary vein stenosis. JACC Cardiovasc Interv 2017; 10: 1788–1798.CrossRefGoogle ScholarPubMed
Tomita, H, Watanabe, K, Yazaki, S, et al. Stent implantation and subsequent dilatation for pulmonary vein stenosis in pediatric patients-maximizing effectiveness. Circ J 2003; 67: 187–190.CrossRefGoogle ScholarPubMed
Klues, HG, Radke, PW, Hoffmann, R, vom Dahl, J. Pathophysiology and therapeutic concepts in coronary restenosis. Herz 1997; 22: 322–334.CrossRefGoogle ScholarPubMed
Zamora, CA, Sugimoto, K, Yamaguchi, M, Sugimura, K. Effect of stent oversizing on in-stent stenosis and lumen size in normal porcine veins. J Endovasc Ther 2005; 12: 495–502.CrossRefGoogle ScholarPubMed
Furukawa, T, Kishiro, M, Fukunaga, H, et al. Drug-eluting stents ameliorate pulmonary vein stenotic changes in pigs in vivo. Pediatr Cardiol 2010; 31: 773–779.CrossRefGoogle ScholarPubMed
Gordon, BM, Moore, JW. Treatment of pulmonary vein stenosis with expanded polytetrafluoroethylene covered stents. Catheter Cardiovasc Interv 2010; 75: 263–267.CrossRefGoogle ScholarPubMed
Ungerleider, RM, Johnston, TA, O’Laughlin, MP, Jaggers, JJ, Gaskin, PR. Intraoperative stents to rehabilitate severely stenotic pulmonary vessels. Ann Thorac Surg 2001; 71: 476–81.CrossRefGoogle ScholarPubMed
Gan, C, Ji, P, Lin, K, Feng, Y. A novel hybrid approach for balloon dilation of pulmonary vein stenosis following total anomalous pulmonary venous connection repair with atrial septal patching. J Cardiac Surg 2015; 30: 608–610.CrossRefGoogle ScholarPubMed
Shell, KJ, Ebeid, MR, Salazar, JD, Dodge-Khatami, A, Batlivala, SP. “How to do it”: hybrid stent placement for pulmonary vein stenosis. World J Pediatr Congenit Heart Surg 2015; 6: 284–287.CrossRefGoogle ScholarPubMed
Yoon, JK, Kim, GB, Song, MK, et al. Hybrid pulmonary vein stenting in infants with refractory to surgical pulmonary vein stenosis repair. Pediatr Cardiol 2018; 39: 1642–1649.CrossRefGoogle ScholarPubMed
Sullivan, PM, Liou, A, Takao, C, et al. Tailoring stents to fit the anatomy of unique vascular stenoses in congenital heart disease. Catheter Cardiovasc Interv 2017; 90: 963–971.CrossRefGoogle ScholarPubMed
Quinonez, LG, Gauvreau, K, Borisuk, M, et al. Outcomes of surgery for young children with multivessel pulmonary vein stenosis. J Thorac Cardiovasc Surg 2015; 150: 911–917.CrossRefGoogle ScholarPubMed
Habara, S, Iwabuchi, M, Inoue, N, et al. A multicenter randomized comparison of paclitaxel-coated balloon catheter with conventional balloon angioplasty in patients with bare-metal stent restenosis and drug-eluting stent restenosis. Am Heart J 2013; 166: 527–533.CrossRefGoogle ScholarPubMed
Sadr, IM, Tan, PE, Kieran, MW, Jenkins, KJ. Mechanism of pulmonary vein stenosis in infants with normally connected veins. Am J Cardiol 2000; 86: 577–579, a10.CrossRefGoogle ScholarPubMed
Riedlinger, WF, Juraszek, AL, Jenkins, KJ, et al. Pulmonary vein stenosis: expression of receptor tyrosine kinases by lesional cells. Cardiovasc Pathol 2006; 15: 91–99.CrossRefGoogle ScholarPubMed
Rehman, M, Jenkins, KJ, Juraszek, AL, et al. A prospective phase II trial of vinblastine and methotrexate in multivessel intraluminal pulmonary vein stenosis in infants and children. Congenit Heart Dis 2011; 6: 608–623.CrossRefGoogle ScholarPubMed
Callahan, R, Kieran, MW, Baird, CW, et al. Adjunct targeted biologic inhibition agents to treat aggressive multivessel intraluminal pediatric pulmonary vein stenosis. J Pediatr 2018; 198: 29–35.e5.CrossRefGoogle ScholarPubMed