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Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
06:59

Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis

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

Melinda J Cory1, Yinn K Ooi1, Michael S Kelleman1

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia.

JACC. Cardiovascular Interventions
|August 22, 2017
PubMed

Insights

Catheter intervention for pediatric pulmonary vein stenosis (PVS) showed improved survival with reintervention. While drug-eluting stents (DES) aided vein survival, they did not significantly improve overall patient survival in PVS cases.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Interventional Cardiology

Background:

  • Pulmonary vein stenosis (PVS) in children can lead to severe outcomes like right heart failure and death.
  • Recurrence and progression of PVS despite treatment necessitate effective therapeutic strategies.
  • Current treatment options for pediatric PVS remain an area of active clinical investigation.

Purpose of the Study:

  • To evaluate the survival rates of pediatric patients undergoing catheter intervention for pulmonary vein stenosis (PVS).
  • To assess the impact of different catheter intervention methods on patient survival and vein patency.
  • To identify factors associated with improved outcomes in pediatric PVS patients.

Main Methods:

  • A retrospective, single-center study included pediatric patients (<18 years) treated for PVS.
  • Interventions included balloon angioplasty, bare-metal stent, and drug-eluting stent (DES) placement.
  • Endpoints analyzed were mortality, vein loss, and reintervention rates.

Main Results:

  • Forty-seven percent of patients died post-intervention; reintervention was linked to significantly improved survival (84% vs. 25% at 1 year).
  • Drug-eluting stent (DES) implantation was associated with better one-year vein survival (p=0.031).
  • Vein loss occurred in 59% of treated veins, with reintervention also improving vein patency (p<0.001).

Conclusions:

  • DES implantation may enhance vein survival but not necessarily overall patient survival in pediatric PVS.
  • Reintervention is strongly associated with improved patient survival and vein patency.
  • Frequent surveillance is crucial for managing pediatric PVS patients, irrespective of the initial treatment modality.
Abstract

Keywords:
balloon angioplastydrug-eluting stent(s)endovascular stent(s)pulmonary vein stenosis

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