Pulmonary Vein Stenting for the Treatment of Acquired Severe Pulmonary Vein Stenosis after Pulmonary Vein Isolation: Clinical Implications after Long-Term Follow-Up of 4 Years (original) (raw)
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Journal of Cardiovascular Electrophysiology, 2005
Percutaneous Pulmonary Vein Stenting. Introduction: Pulmonary vein stenosis (PVS) is a potential complication of pulmonary vein isolation (PVI) using radiofrequency energy. The aim of our study was the evaluation of the severity and long-term outcome of primary angioplasty and angioplasty with pulmonary vein stenting for PVS. Methods and Results: Twelve patients with 15 PVS (greater than 70% stenosis) were prospectively evaluated. Primary dilation of the stenosis was performed because of clinical symptoms (10 patients) and/or the lung perfusion scans showed a significant perfusion defect (11 patients). Magnetic resonance imaging and lung perfusion scans performed before, directly after, during 3-month, and 6-month follow-up. In the stenting group additional multislice CT-scans directly after, during 6-month, and 12-month follow-up were performed. Within 2 months after primary balloon angioplasty, the PV size parameters were significantly reduced (P < 0.001) with recurrence of PVS in 11 of 15 PVs (73%). Pulmonary vein stenting in 8 patients and 11 PVs resulted in no vein stenosis during 12-month follow-up. Normalization of lung perfusion was noted in 8 of 12 patients. We observed 2 patients with hemoptysis during PV dilation, as severe complications with potential life-threatening character. Conclusion: PVS stenting seems to be superior to balloon angioplasty and effective at least over a period of 12 months in treating acquired PVS after pulmonary vein isolation.
Pulmonary artery stents: Long-term follow-up
Catheterization and Cardiovascular Interventions, 2010
Objectives: Determine the long-term outcomes of branch pulmonary artery (PA) stents. Background: PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited. Methods: Patients enrolled in an FDA IDE protocol from 1989-92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure. Results: There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91%) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 6 4.3 years post stent insertion with 1.2 6 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 6 1.8 to 13.4 6 2.4 mm (P < 0.001), and the pressure gradient improved from 41 6 25 to 9 6 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P 5 0.030 and 0.046). Jailed vessels occurred in 49% of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death. Conclusion: Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction. V C 2009 Wiley-Liss, Inc.
Stent implantation for relief of pulmonary artery stenosis: Immediate and short‐term results
Catheterization and Cardiovascular Diagnosis, 1996
Our objective was to assess the immediate and short-term results of stent implantation to relieve pulmonary artery stenosis (PAS). Thirty-seven patients underwent an attempt at stent implantatlon at a medlan age of 7.0 years (range, 0.G31.4 years) and a median weight of 20.5 kg (range, 7.4-85 kg). Twenty-two patients had previous tetralogy of Fallot repair. A total of 55 stents were Implanted successfully in 36 patlents. The peak systolic gradient across the stenotic segment decreased from a mean of 43 2 20.4 mmHg prestent to 13 f 13.9 mmHg (P a:: 0.001) poststent. The diameter of the narrowest segment Increased from a mean of 4.8 f 1.6 mm to 10.5 f 2.6 mm (P ,:I 0,001). The right ventrlcular-to-aortic mean systolic pressure ratio decreased from 0.74 2 0.2 to 0.52 ? 0.1 9 (P c: 0.001). Complications included balloon rupture prior to full stent expansion in 4 patients (in 2 patients the stent was positioned in the superior vena cava, and in 2 in the inferior vena cava), distal migration of a stent which was successfully retrieved at surgery 1 mo later in 1 patient, and tethering of the stent to the balloon requiring surgical removal in 1 patient. One patient died several hours after stent placement. Sixteen patients underwent repeat catheterization at a mean follow-up interval 010.9 * 0.5years (range, 0.2-2.0years). The mean gradient across the stent for these 16 patients was 26.7 f 19.8 mmHg, and there was no change in the mean diameter (9.4 2 3.2 mm). Two patients developed stenosis related to neointimal proliferation at the stent site which was redilated successfully. In conclusion, stent irnplantation is generally safe and effective in relleving PAS.
Intraoperative stenting of pulmonary arteries
European Journal of Cardio-Thoracic Surgery, 2005
Objective: The surgical treatment of pulmonary artery stenoses in small children with complex cardiac lesions can be technically difficult. A hybrid-approach combining corrective surgery and intraoperative stent placement may be complementary in these patients. Methods: Descriptive study in 11 small children (age: one week to 12 years, median of 12 months, weight: 2.5-20 kg) after previous cardiac surgery. Intraoperative stenting of pulmonary arteries was performed involving paediatric cardiologist and cardiac surgeon. Stenting was combined with repair of pulmonary atresia (nZ2), right ventricular outflow and pulmonary artery reconstruction (nZ3), unifocalisation of pulmonary arteries (nZ1), revision of distal anastomosis of RV-PA-conduit after truncus repair (nZ1), revision of distal anastomosis of RV-PAconduit after AVSD/Fallot repair (nZ1), aortic arch patch reconstruction after anatomical correction for transposition of the great arteries (nZ1), bidirectional cavopulmonary anastomosis after Norwood I operation for hypoplastic left heart syndrome, (nZ1) retrieval of a dislodged stent from the left pulmonary artery (nZ1). In seven patients stenting was planned electively while in four patients it took place on an emergency base. Results: No complications occurred during stent implantation. One patient died three weeks postoperatively from diffuse bleeding due to a coagulation disorder. Ten patients left hospital after the surgical intervention with concomitant stent implantation. Stent redilatation was necessary in 4 patients 2-24 months postoperatively. After a median follow-up of 15 months ranging from 3 weeks to 7.5 years all stents were patent as diagnosed by angiography in 6 patients and by colour-Doppler in all other patients. One year after stent placement one stent was removed and another surgically opened during re-operation for conduit replacement in the smallest patient from this series. There was one late death during operative right ventricular outflow-tract reconstruction after initial stent placement. Conclusions: With intraoperative stent placement surgically difficult patch augmentation of small and fragile pulmonary vessels during repair of complex cardiac lesions can be avoided. Stents recruit pulmonary vessels and keep them open and amenable to future percutaneous or surgical interventions. q
Bifurcation Angioplasty Using Drug Eluting Stents of Post-AF Ablation Severe Pulmonary Vein Stenosis
Pacing and Clinical Electrophysiology, 2012
A 53-year-old man with long-standing persistent AF underwent multiple ablation procedures. A presentation with hemoptysis led to a left pulmonary artery wedge angiography and thoracic computed tomography (CT) scan, which revealed a tight bifurcation stenosis of the left superior pulmonary vein (LSPV). This was treated by angioplasty with drug-eluting stents to avoid restenosis by bare-metal stent implantation in small diameter PVs as already described. After predilatation, two 4 × 32-mm and a 3 × 20-mm Taxus R Liberté stents (Boston Scientific, Natick, MA, USA) were deployed across upper and lower LSPV branches and the ostio-antral segment. Twenty-two month follow-up CT angiography showed patent stents in the LSPV, without in-stent restenosis (no arrhythmia or hemoptysis at 24-month follow-up).
Pulmonary artery stents in the recent era
Catheterization and Cardiovascular Interventions, 2014
Background: Long-term follow-up after stent dilation of native and acquired pulmonary artery stenosis is scarce in the pediatric population. Most cohorts include a myriad of anatomies and associated conditions. Method: In order to establish objective performance criteria, we performed a retrospective review of all patients who underwent unilateral pulmonary artery stenting in biventricular physiology at three centers from June 2006 to June 2011. Results: Fifty-eight patients received 60 stents with Palmaz Genesis stent used most commonly (78%). Average age at implantation was 10.4 6 10.3 years and weight 31.6 6 21.8 kg. The immediate success rate was 98%, with improvement in minimal diameter from 5.1 6 2 cm to 10.6 6 3 cm (P < 0.01). There were 10 complications (7 major and 3 minor) and no acute mortality. One-year follow-up studies were available in 48 patients (83%), including echocardiogram (60%), catheterization (28%), MRI (29%), and lung perfusion (31%). Follow-up echocardiogram showed mild increase in stent gradient, from 5.7 6 6.7 mm Hg post-procedure to 17.1 6 11.7 mm Hg. Follow-up catheterization showed no significant change in minimal stent diameter (8.8 6 2.6 to 7.8 6 2.3 mm), gradient (7.7 6 8.4 to 12.6 6 12.2 mm Hg), or right ventricular pressures (43.7 6 9 to 47.7 6 10.5 mm Hg). Nine patients (16%) underwent scheduled stent redilation over a period of 12 days to 25 months. Conclusion: In conclusion, stent implantation shows excellent immediate and 1-year follow-up results with maintenance of improved caliber of the stented vessel and lowered right ventricular systolic pressures. V
The Annals of Thoracic Surgery, 2007
Pulmonary artery reconstruction remains a challenging clinical problem. We sought to evaluate the use of intraoperative stenting in conjunction with open heart surgical repairs. We retrospectively analyzed data from 22 patients between 1998 and 2003 who underwent intraoperative pulmonary artery stenting. The mean age was 9.3 years (range, 9 months to 24 years). The left pulmonary artery was stented in 8 patients, the right in 13, the main in 1, and bilateral in 1. Available echocardiograms in 20 patients revealed a mean preoperative diameter of 7.6 mm (range, 3 to 16.5 mm) and a mean peak gradient of 45.4 mm Hg (range, 20 to 120 mm Hg). Augmentation patch angioplasty of the contralateral pulmonary artery was performed in 11 patients. Thirteen patients had pulmonary valve replacement and 11 had conduit replacement or augmentation. Three patients underwent tricuspid valve repair, 6 had Fontan, and 4 underwent a modified Maze procedure. Follow-up echocardiograms demonstrated a decrease in mean peak gradient to 4.3 mm Hg (range, 0 to 15 mm Hg), a change in mean peak gradient of 41.1 mm Hg (93% reduction). After stenting the mean pulmonary artery diameter increased to 10.9 mm (range, 6 to 17.9 mm). There was no perioperative mortality. At a mean follow-up of 22.8 months (range, 6 to 57 months), there were no surgical or percutaneous reinterventions. Intraoperative pulmonary artery stenting is a safe and effective technique that can be used as an alternative to patch angioplasty. Close follow-up is needed to examine the long-term outcome of this procedure, with special attention to the growth and development of the stented vessel.
Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era
The Journal of Thoracic and Cardiovascular Surgery, 2018
Background: The optimal management and prognostic factors of postsurgical pulmonary vein stenosis remain controversial. We sought to determine current postsurgical pulmonary vein stenosis outcomes and prognostic factors in a multicentric study in the current era. Methods: Seventy-five patients with postsurgical pulmonary vein stenosis who underwent 103 procedures in 14 European/North American centers (2000-2012) were included retrospectively. A specific pulmonary vein stenosis severity score was developed on the basis of the assessment of each pulmonary vein. End points were death, pulmonary vein reintervention, and restenosis. A univariate and multivariate risk analysis was performed. Results: Some 76% of postsurgical pulmonary vein stenosis occurred after repair of a total anomalous pulmonary venous return. Sutureless repair was used in 42 of 103 procedures (41%), patch veinoplasty was used in 28 procedures (27%), and endarterectomy was used in 16 procedures (16%). Overall pulmonary vein restenosis, reintervention, and mortality occurred in 56% (n ¼ 58/103), 49% (n ¼ 50/103), and 27% (n ¼ 20/75), respectively. Sutureless repair was associated with less restenosis (40% vs 67%; P ¼ .007) and less reintervention (31% vs 61%; P ¼ .003). Mortality after sutureless repair (20%; 7/35) tends to be lower than after nonsutureless repair (33%; 13/40) (P ¼ .22). A high postoperative residual pulmonary vein stenosis score at the time of hospital discharge was an independent risk factor for restenosis (hazard ratio [HR], 1.55; P < 10 À4), reintervention (HR, 1.33; P < 10 À4), and mortality (HR, 1.37; P < 10 À4). The sutureless technique was an independent protective factor against restenosis (HR, 0.27; P ¼ .006). Conclusions: Postsurgical pulmonary vein stenosis still has a guarded prognosis in the current era. The sutureless technique is an independent protective factor against restenosis. The severity of the residual disease evaluated by a new severity score is an independent risk factor for poor outcomes regardless of surgical technique.
Successful stenting of a life threatening pulmonary arterial stenosis
Heart, 1991
A 35 year old woman with multiple pulmonary arterial stenoses and occlusions was admitted with increasingly severe breathlessness. Balloon angioplasty of a life threatening stenosis in a remaining pulmonary artery branch was attempted on two occasions but without success. When a self-expanding stainless steel stent was inserted at the site of stenosis after a further angioplasty acute localised pulmonary oedema developed as blood flow distal to the lesion increased considerably. This was followed by a slow and dramatic improvement in the patient's condition. She no longer required an urgent transplant and resumed an active life.