Clinical outcomes after the endovascular treatments of pulmonary vein stenosis in patients with congenital heart disease. (9th August 2019)

• Record Type: Journal Article
• Authors: Kurita, Yoshihiko; Baba, Kenji; Kondo, Maiko; Eitoku, Takahiro; Kasahara, Shingo; Iwasaki, Tatsuo; Ohtsuki, Shinichi; Tsukahara, Hirokazu
• Is Part Of: Cardiology in the young. Volume 29:Number 8(2019)
• Page Start: 1057
• Page End: 1065
• Publication Date: 2019-08-09
• Subjects: Pulmonary vein stenosis, -- total anomalous of pulmonary venous connection, -- isolated congenital pulmonary vein stenosis, -- hybrid stent implantation, -- balloon angioplasty, -- re-intervention for stent; Pediatric cardiology -- Periodicals; 618.9212
• DOI: 10.1017/S1047951119001495
• Languages: English
• ISSNs: 1047-9511

Abstract

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.