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Outcomes of Reinterventions for Children with Postoperative Pulmonary Venous Restenosis
Luo Kai1, Zhang Xiaoyang1, Zheng Jinghao2
1Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China.
Insights
Reintervention for pediatric pulmonary venous restenosis is effective, with sutureless, pericardium, and blunt enlargement techniques promoting anastomosis growth. Early intervention is crucial for managing this common postoperative complication.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Engineering
Background:
- Postoperative pulmonary venous restenosis is a frequent complication following surgery for pulmonary venous malformations in children.
- Early detection and intervention are critical for managing this condition and improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and outcomes of reintervention in children with postoperative pulmonary venous restenosis.
- To assess the long-term results and identify factors influencing success in pediatric pulmonary venous restenosis management.
Main Methods:
- Retrospective analysis of clinical data from 61 children undergoing reintervention for pulmonary venous restenosis.
- Review of various reintervention techniques including sutureless repair, pericardium enlargement, blunt enlargement, balloon dilatation, and stent implantation.
- Long-term follow-up using echocardiography to assess pulmonary venous anastomosis growth and velocity.
Main Results:
- The study included 61 patients (38 boys, 23 girls) with a mean age of 15.4 months.
- Reintervention procedures varied, with sutureless technique being most common (34 cases).
- Early mortality was 8.2% (5 deaths). Survivors showed significant anastomosis growth (0.026 cm/month) and improved velocity (1.24 m/s), with no reoperations needed for mild restenosis.
Conclusions:
- Reintervention is effective for pediatric pulmonary venous restenosis, particularly when performed early.
- Sutureless, bovine pericardium, and blunt enlargement techniques facilitate pulmonary venous anastomosis growth.
- While balloon dilatation offers early benefits, its high restenosis rate necessitates diligent mid- to long-term monitoring.
Abstract:
This report aims to summarize and evaluate the efficacy and experience of reintervention for children with postoperative pulmonary venous restenosis. Clinical data from 61 patients with postoperative pulmonary venous restenosis who underwent reintervention at Shanghai Children's Medical Center (SCMC) from September 2009 to June 2018 were retrospectively analyzed. The patients comprised 38 boys and 23 girls, with a mean age of 15.4 ± 12.6 months (2-83 months) and a mean weight of 8.1 ± 3.4 kg (3.7-18.5 kg). The mean pulmonary venous velocity was 2.31 ± 0.47 m/s (1.86-3.22 m/s). Primary disease included 48 cases of total anomalous pulmonary venous drainage, nine cases of partial anomalous pulmonary venous drainage, and four cases of primary pulmonary venous stenosis. The reintervention procedures included 34 cases using the sutureless technique, ten cases using bovine pericardium enlargement, three cases using blunt enlargement, four cases of balloon dilatation, one case using stent implantation and nine cases involving more than two surgical methods. The early postoperative pulmonary venous velocity was 1.16 ± 0.20 m/s. There were five in-hospital deaths, resulting in a mortality rate of 8.2%. Fifty-six survivors were followed for 52.8 ± 46.5 months (6-103 months) with no delayed deaths. Echocardiography showed pulmonary venous anastomosis and diameter growth after reintervention, exhibiting a mean growth speed of 0.026 ± 0.013 cm/month (p < 0.05) and a mean velocity of 1.24 ± 0.26 m/s; five patients experienced varying degrees of pulmonary venous obstruction (> 1.6 m/s), but did not require reoperation. Postoperative pulmonary venous restenosis is a common complication after surgery for pulmonary venous malformations. Reintervention should be performed in the early period of pulmonary venous obstruction. Growth of pulmonary venous anastomoses was observed after performing the sutureless technique, bovine pericardium enlargement and blunt enlargement. Although balloon dilatation has a good effect in the early postoperative period, its restenosis rate is high, and strict mid- to long-term follow-up is needed.
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