Outcomes After Stent Implantation for the Treatment of Congenital and Postoperative Pulmonary Vein Stenosis in Children

Abstract

Background-Pulmonary vein stenosis (PVS) is a rare condition that can lead to worsening pulmonary hypertension and cardiac failure in children, and it is frequently lethal. Surgical and transcatheter approaches are acutely successful but restenosis is common and rapid. Methods and Results-We reviewed outcomes among patients who underwent transcatheter pulmonary vein stent implantation for congenital or postoperative PVS at Ͻ18 years of age. A total of 74 pulmonary veins were stented with bare metal, drug-eluting, or covered stents in 47 patients. Primary diagnoses included PVS associated with anomalous venous return in 51%, PVS associated with other congenital cardiovascular defects in 36%, and congenital ("de novo") PVS in 13% of patients. Median age at the time of pulmonary vein stent implantation was 1.4 years. During a median cross-sectional follow-up of 3.1 years, 21 patients died. Estimated survival was 62Ϯ8% at 1 year and 50Ϯ8% at 5 years after pulmonary vein stent implantation. Stent placement acutely relieved focal obstruction in all veins. Of the 54 stents reexamined with catheterization, 32 underwent reintervention. Freedom from reintervention was 62Ϯ7% at 6 months and 42Ϯ7% at 1 year. Stent occlusion was documented in 9 cases and significant in-stent stenosis in 17 cases. Stent implantation diameter Ն7 mm was associated with longer freedom from reintervention (hazard ratio, 0.32; Pϭ0.015) and from significant in-stent stenosis (hazard ratio, 0.14; Pϭ0.002). Major acute complications occurred in 5 cases. Conclusions-Transcatheter stent implantation can acutely relieve PVS in children, but reintervention is common. Larger stent lumen size at implantation is associated with longer stent patency and a lower risk of reintervention. (Circ Cardiovasc Interv. 2012;5:109-117.)

Transcatheter Stent Therapy in Children: An Update

“…Intraoperative and transcatheter stenting has been attempted [14,[177][178][179][180][181][182][183][184]. Immediate relief of pulmonary vein obstruction is (Figure 10).…”

“…Immediate relief of pulmonary vein obstruction is (Figure 10). In one of the largest series reported [184], 74 stents were implanted in stenotic pulmonary veins in 47 patients, and there was immediate relief of obstruction in all veins. At a mean follow-up of 3.1 years, 21 (45%) patients died and 32 (59%) of the 54 re-studied stents (veins) required re-intervention.…”

Stents as an Option for the Correction of Congenital Heart Disease

“…Ввиду крайне негативного долгосрочного прогноза таких пациентов основным методом лечения является наложение хирургического бесшовного анасто-моза сегментов ЛВ [44], при этом лишь 50% пациентов не требуется повторная операция в течение пяти лет, даже если они выживают [23]. Стеноз ЛВ успешно поддается коррекции при помощи стентирования при ВПС, после трансплантации легких и после метода изоляции ЛВ [45], однако зачастую все равно необходима повторная опе-рация [46].…”

“…В связи с этим чаще всего использу-ют голометаллические стенты для желчных протоков. В случае непроходимости сосудистой системы может быть использован метод хирургической имплантации стента [46]. Тем не менее, согласно клиническим данным, эффективность стентирования остается крайне низкой [46], вследствие чего данный метод по отношению к сте-нозу ЛВ следует рассматривать исключительно как пал-лиативный, предшествующий последующему хирургиче-скому лечению.…”

Fracture of Cardiovascular Stents in Patients With Congenital Heart Disease

“…[25][26][27][28][29] In children and adults with congenital heart disease (CHD), stents are used to treat many conditions, including obstruction of systemic and pulmonary arteries and veins, prosthetic conduits, valves, and shunts, and to enlarge, establish, or maintain communications between vessels or chambers of the heart. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Most stents placed for CHD are used off-label, to treat conditions for which the stents were not developed, tested, or approved, and they are frequently implanted in previously operated sites with nonuniform material properties, and they may also be exposed to high cyclic mechanical stress. Because patients with CHD who have stents placed are usually children or young adults, the expected lifespan of the stent may be many decades.…”