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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
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

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.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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