Reintervention Is Associated With Improved Survival in Pediatric Patients With Pulmonary Vein Stenosis

Cory, Melinda; Ooi, Yinn Khurn; Kelleman, Michael; Vincent, Robert; Kim, Dennis W.; Petit, Christopher J.

doi:10.1016/j.jcin.2017.05.052

Cited by 55 publications

(31 citation statements)

References 26 publications

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“…The same symptoms have been reported in the literature for humans with PE [16]. Also, changes reported on Doppler echocardiography, as well as increased right ventricular pressure and hypertrophy, RV diastolic dysfunction, and regurgitant flow pulmonary valve narrowing and failure were similar to findings reported for an adult woman showing the same changes [17].…”

Section: Discussionsupporting

confidence: 86%

Canine Animal as a Model in the Repercussion of Pulmonary Stenosis: Analysis by Two-Dimensional Echocardiography and Doppler Mode - Case Report

Rodrigues

Pessoa

Moura

et al. 2017

MOJAP

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Pulmonary stenosis is a congenital disease characterized by narrowing of the right ventricular outflow tract. This change results in a resistance to blood flow and, consequently, an increase in the after load, leading to the elevation of systolic pressure of the right ventricle, resulting in concentric hypertrophy. Echocardiographic findings, such as right ventricular diastolic dysfunction, stenosis and pulmonary valve insufficiency, with regurgitant flow observed at color Doppler, were essential for diagnosis. A 5 years old small dog, attended at the Hospital Veterinário Universitário HVU / UFPI, was taken as an animal model to report the hemodynamic changes caused by pulmonary insufficiency and stenosis, in a comparative analysis to the same disease when it occurs in humans. Due to the similarities between hemodynamic findings in pulmonary stenosis of dogs and humans, this species proved to be a good animal model to evaluate the repercussion of this congenital heart disease by Doppler echocardiography IntroductionPulmonary stenosis (PE) is a heart disease characterized by a narrowing of the right ventricular outflow tract due to the occurrence of a fibrous ring, which may manifest as congenital or rarely acquired [1]. This change causes resistance to blood flow and an increase in after load, causing elevation of right ventricular systolic pressure, resulting in concentric hypertrophy. Some canine breeds are predisposed to the occurrence of this disease, Case PresentationIt was attended at the Hospital Veterinário Universitário da Universidade Federal do Piauí -HVU/UFPI a female dog, with no defined breed, 5 years old, weighing 4.5 kg. During the anamnesis, the owner reported that the animal presented fatigue, respiratory distress, tachypnea, tachycardia and lethargy. During the clinical examination, the animal was slightly dehydrated, pale mucosa, heart rate of 138 bpm, ascites and tachypnea. At the auscultation, it was identified grade IV / V systolic murmur, focusing on pulmonary valve. Clinical findings were compatible with heart disease.The animal was hospitalized and complementary exams such as, thoracic radiography, electrocardiography, echocardiography, abdominal ultrasonography, hemogram and biochemicals were requested. In the hemogram, no abnormalities were found, whereas in the biochemical, there was a decrease in urea and globulin levels and an increase in creatine kinase. Radiographic examination showed an increase in the cardiac silhouette, with loss of definition of the cardiac apex, globose heart, pleural The treatment with intravenous furosemide (1mg / kg), benazepril (0.5mg / kg) and sildenafil (1mg / kg) was started. However, the patient died five days after the consultation due to the aggravation of the case, and the guardian did not authorize the necropsy examination. DiscussionPulmonary stenosis is one of the most frequent congenital heart diseases that affect dogs, and may occur alone or in association with other conditions, although the patient in question presented pulmonary ...

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Section: Discussionsupporting

confidence: 86%

Canine Animal as a Model in the Repercussion of Pulmonary Stenosis: Analysis by Two-Dimensional Echocardiography and Doppler Mode - Case Report

Rodrigues

Pessoa

Moura

et al. 2017

MOJAP

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“…stent patency was superior in the group of drug-eluting stent. 17 As shown in Figure 2, our investigation revealed no significant differences in the survival rate between the group undergoing balloon angioplasty alone and that undergoing stent implantation. However, we did find a significant difference in terms of the survival rate between the bare-metal stent group and other groups.…”

mentioning

confidence: 52%

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

et al. 2019

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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.

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“…Use of drug-eluting stents and drug-eluting balloons is commonplace in the adult coronary literature, with case reports and retrospective series increasingly populating the PVS literature. 8,9 The concept of an externally applied scaffold or film at the time of surgical intervention offers some advantages: targeted local delivery and avoidance of potential systemic side effects. It also represents an opportunity to potentially tailor drug delivery outside of commercially available drug-eluting balloons and stents.…”

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confidence: 99%

Commentary: Targeting neointimal lesions in pulmonary vein stenosis: Fact or fiction?

Vanderlaan

2020

The Journal of Thoracic and Cardiovascular Surgery

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Reintervention Is Associated With Improved Survival in Pediatric Patients With Pulmonary Vein Stenosis

Cited by 55 publications

References 26 publications

Canine Animal as a Model in the Repercussion of Pulmonary Stenosis: Analysis by Two-Dimensional Echocardiography and Doppler Mode - Case Report

Canine Animal as a Model in the Repercussion of Pulmonary Stenosis: Analysis by Two-Dimensional Echocardiography and Doppler Mode - Case Report

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

Commentary: Targeting neointimal lesions in pulmonary vein stenosis: Fact or fiction?

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