Outcomes after stent implantation for the treatment of congenital and postoperative pulmonary vein stenosis in children

Sowmya Balasubramanian, Audrey C. Marshall, Kimberlee Gauvreau, Lynn F. Peng, Alan W. Nugent, James E. Lock, Doff B. McElhinney

Research output: Contribution to journalArticle

44 Scopus citations

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 ≥18 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 62±8% at 1 year and 50±8% 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 62±7% at 6 months and 42±7% at 1 year. Stent occlusion was documented in 9 cases and significant in-stent stenosis in 17 cases. Stent implantation diameter ≥7 mm was associated with longer freedom from reintervention (hazard ratio, 0.32; P=0.015) and from significant in-stent stenosis (hazard ratio, 0.14; P=0.002). 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.

Original languageEnglish (US)
Pages (from-to)109-117
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number1
DOIs
StatePublished - Feb 1 2012

Keywords

  • Balloon dilation
  • Covered stent
  • Drug-eluting stent
  • Endovascular stents
  • Pulmonary vein stenosis
  • Stent fracture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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