Systemic Embolic Complications of Pulmonary Vein Angioplasty in Children

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Pulmonary vein stenosis (PVS) in children leads to significant morbidity and mortality.
• Management of PVS frequently requires repeated angioplasty procedures.
• Systemic embolic events, such as stroke, are known complications of PVS angioplasty, but their incidence and risk factors are not well understood.

Purpose of the Study:

• To determine the incidence and identify risk factors for systemic embolic events following pediatric pulmonary vein stenosis angioplasty.
• To evaluate whether specific procedural or patient factors are associated with an increased risk of embolism.

Main Methods:

• Retrospective review of pediatric catheterizations for PVS angioplasty or stent placement at a single institution (July 2005 - February 2014).
• Analysis of 406 procedures in 144 patients, using each patient as their own control to identify modifiable risk factors.
• Assessment of procedural details, including time, contrast dose, anticoagulation, and equipment used.

Main Results:

• Eleven (2.7%) of 406 catheterizations were complicated by systemic embolic events, including 10 strokes and 1 renal infarct.
• The prevalence of clinically evident stroke in the cohort was 7.6%.
• No significant differences were found in modifiable factors (e.g., contrast dose, anticoagulation) between complicated and uncomplicated procedures, suggesting the risk may be inherent.

Conclusions:

• Systemic embolism, particularly stroke, is a significant complication of pediatric pulmonary vein stenosis angioplasty, occurring at a higher rate than in other pediatric catheterizations.
• The risk of embolism appears to be inherent to the PVS angioplasty procedure itself.
• Further research is needed to understand and potentially mitigate this risk, as current findings do not identify specific modifiable risk factors.