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

  • Yoshihiko Kurita (a1), Kenji Baba (a1), Maiko Kondo (a1), Takahiro Eitoku (a1), Shingo Kasahara (a2), Tatsuo Iwasaki (a3), Shinichi Ohtsuki (a1) and Hirokazu Tsukahara (a1)...

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.

Copyright

Corresponding author

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

References

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1. Seale, AN, Webber, SA, Uemura, H, et al. Pulmonary vein stenosis: the UK, Ireland and Sweden collaborative study. Heart 2009; 95: 19441949.
2. 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: 12551262.
3. DiLorenzo, MP, Ashley, S, Faerber, JA, et al. Patient characteristics and mortality in children With pulmonary ein stenosis. Circulation 2018; 136: A17454.
4. Mendelsohn, AM, Bove, EL, Lupinetti, FM, et al. Intraoperative and percutaneous stenting of congenital pulmonary artery and vein stenosis. Circulation 1993; 88: Ii210217.
5. 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: 596606; discussion 596-606.
6. 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: 201206.
7. 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: 4858.
8. Kanter, KR, Kirshbom, PM, Kogon, BE. Surgical repair of pulmonary venous stenosis: a word of caution. Ann Thorac Surg 2014; 98: 16871691; discussion 1691-2.
9. 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: 229234.
10. 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: 18121821.
11. 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: 146150.
12. 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: 673678.
13. Kato, H, Fu, YY, Zhu, J, et al. Pulmonary vein stenosis and the pathophysiology of “upstream” pulmonary veins. J Thorac Cardiovasc Surg 2014; 148: 245253.
14. Seale, AN, Daubeney, PE, Magee, AG, Rigby, ML. Pulmonary vein stenosis: initial experience with cutting balloon angioplasty. Heart 2006; 92: 815820.
15. McMahon, CJ, McDermott, M, Walsh, KP. Failure of cutting balloon angioplasty to prevent restenosis in childhood pulmonary venous stenosis. Catheter Cardiovasc Interv 2006; 68: 763766.
16. 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: 109117.
17. 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: 17881798.
18. 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: 187190.
19. Klues, HG, Radke, PW, Hoffmann, R, vom Dahl, J. Pathophysiology and therapeutic concepts in coronary restenosis. Herz 1997; 22: 322334.
20. 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: 495502.
21. Furukawa, T, Kishiro, M, Fukunaga, H, et al. Drug-eluting stents ameliorate pulmonary vein stenotic changes in pigs in vivo. Pediatr Cardiol 2010; 31: 773779.
22. Gordon, BM, Moore, JW. Treatment of pulmonary vein stenosis with expanded polytetrafluoroethylene covered stents. Catheter Cardiovasc Interv 2010; 75: 263267.
23. 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.
24. 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: 608610.
25. 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: 284287.
26. 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: 16421649.
27. 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: 963971.
28. 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: 911917.
29. 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: 527533.
30. Sadr, IM, Tan, PE, Kieran, MW, Jenkins, KJ. Mechanism of pulmonary vein stenosis in infants with normally connected veins. Am J Cardiol 2000; 86: 577579, a10.
31. Riedlinger, WF, Juraszek, AL, Jenkins, KJ, et al. Pulmonary vein stenosis: expression of receptor tyrosine kinases by lesional cells. Cardiovasc Pathol 2006; 15: 9199.
32. 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: 608623.
33. 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: 2935.e5.

Keywords

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

  • Yoshihiko Kurita (a1), Kenji Baba (a1), Maiko Kondo (a1), Takahiro Eitoku (a1), Shingo Kasahara (a2), Tatsuo Iwasaki (a3), Shinichi Ohtsuki (a1) and Hirokazu Tsukahara (a1)...

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