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Safety and efficacy of balloon angioplasty compared to stent-basedstrategies with pulmonary vein stenosis:A systematic review and meta-analysis

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World Journal of Cardiology 2023年第2期15卷 64-75页

作者： Pradyumna Agasthi Srilekha Sridhara Pattara Rattanawong Nithin Venepally Chieh-Ju Chao Hasan Ashraf Sai Harika Pujari Mohamed Allam Diana Almader-Douglas Yamini Alla Amit Kumar Farouk Mookadam Douglas L Packer David R Holmes Jr Donald J Hagler Floyd David Fortuin Reza Arsanjani Department of Cardiovascular Diseases Mayo ClinicScottsdaleAZ 85259United States Department of Internal Medicine Banner Heart HospitalMesaAZ 85054United States Library Services Mayo ClinicPhoenixAZ 85054United States Department of Medicine Bronx Lebanon HospitalBronxNY 10457United States Department of Cardiovascular Diseases Mayo ClinicRochesterMN 55905United States

BACKGROUND pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

关键词： pulmonary veins pulmonary vein stenosis Constriction Balloon angioplasty Stents Drugeluting stents

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pulmonary vein stenosis:Etiology,diagnosis and management

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World Journal of Cardiology 2016年第1期8卷 81-88页

作者： Pablo Pazos-López Cristina García-Rodríguez Alba Guitián-González Emilio Paredes-Galán María ángel De La Guarda álvarez-Moure Marta Rodríguez-álvarez José Antonio Baz-Alonso Elvis Teijeira-Fernández Francisco Eugenio Calvo-Iglesias Andrés íniguez-Romo Department of Cardiology Complexo Hospitalario Universitario de Vigo Hospital álvaro Cunqueiro Department of Radiology Complexo Hospitalario Universitario de Vigo Hospital álvaro Cunqueiro Diagnostic Imaging Unit Galaria Empresa Pública de Servicios Sanitarios Hospital do Meixoeiro

pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.

关键词： pulmonary vein stenosis pulmonary vein stenosis etiology pulmonary vein stenosis causes pulmonary vein stenosis diagnosis pulmonary vein stenosis management pulmonary vein stenosis treatment

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Important Newborn Cardiac Diagnostic Dilemmas for the Neonatologist and Cardiologist-A Clinical Perspective

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Congenital Heart Disease 2021年第2期16卷 189-196页

作者： Samuel Menahem Arvind Sehgal Department of Paediatrics University of MelbourneMelbourneAustralia School of Clinical Sciences Monash UniversityMelbourneAustralia Monash Newborn Cardiovascular ResearchMonash Children’s HospitalMelbourneAustralia Department of Paediatrics Monash UniversityMelbourneAustralia

Most congenital heart disease(CHD)is readily recognisable in the newborn.Forewarned by previous fetal scanning,the presence of a murmur,tachypnoea,cyanosis and/or differential pulses and saturations all point to a cardiac abnormality.Yet serious heart disease may be missed on a fetal scan.There may be no murmur or clinical cyanosis,and tachypneoa may be attributed to non-cardiac causes.Tachypnoea on day 1 is usually non-cardiac except arising from ventricular failure or a large systemic arteriovenous fistula.A patent ductus arteriosus(PDA)may support either pulmonary or systemic duct dependent circulations.The initially high pulmonary vascular resistance(PVR)limits shunts so that murmurs even from large communications between the systemic and pulmonary circulations take days/weeks to develop.At times despite expert input,serious CHD maybe difficult to diagnose and warrants close interaction between the neonatologist and cardiologist to reach a timely diagnosis.Such conditions include obstructed total anomalous pulmonary venous connections(TAPVC)and the need to distinguish it from persistent pulmonary hypertension in the newborn(PPHN)–the treatment of the former is surgical the latter medical.A large duct shunting right to left may overshadow a suspected hypoplastic aortic isthmus and/or coarctation.Is the right to left shunting because of severe aortic obstruction or resulting from a high PVR with little obstruction.The diagnosis of pulmonary vein stenosis(PVS)remains problematic often developing in premature infants with ongoing bronchopulmonary dysplasia(BPD),still being cared for by the neonatologist.While there are other diagnostic dilemmas including deciding the contribution of a recognised CHD in a sick neonate,this paper will focus on the above-mentioned conditions with suggestions on what may be done to arrive at a timely diagnosis to achieve optimal outcomes.

关键词： Obstructed pulmonary veins persistent pulmonary hypertension aortic coarctation pulmonary vein stenosis newborn

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