-
Pediatric Cardiology Dec 2023Pulmonary vein stenosis (PVS) in children is a challenging condition with poor outcomes. Post-operative stenosis can occur after repair of anomalous pulmonary venous...
Pulmonary vein stenosis (PVS) in children is a challenging condition with poor outcomes. Post-operative stenosis can occur after repair of anomalous pulmonary venous return (APVR) or stenosis within native veins. There is limited data on the outcomes of post-operative PVS. Our objective was to review our experience and assess surgical and transcatheter outcomes. Single-center retrospective study was performed including patients < 18 years who developed restenosis after baseline pulmonary vein surgery that required additional intervention(s) from 1/2005 to 1/2020. Non-invasive imaging, catheterization and surgical data were reviewed. We identified 46 patients with post-operative PVS with 11 (23.9%) patient deaths. Median age at index procedure was 7.2 months (range 1 month-10 years), and median follow-up was 10.8 months (range 1 day-13 years). Index procedure was surgical in 36 (78.3%) and transcatheter in 10 (21.7%). Twenty-three (50%) patients developed vein atresia. Mortality was not associated with number of affected veins, vein atresia, or procedure type. Single ventricle physiology, complex congenital heart disease (CCHD), and genetic disorders were associated with mortality. Survival rate was higher in APVR patients (p = 0.03). Patients with three or more interventions had a higher survival rate compared to patients with 1-2 interventions (p = 0.02). Male gender, necrotizing enterocolitis, and diffuse hypoplasia were associated with vein atresia. In post-operative PVS, mortality is associated with CCHD, single ventricle physiology, and genetic disorders. Vein atresia is associated with male gender, necrotizing enterocolitis, and diffuse hypoplasia. Multiple repeated interventions may offer a patient survival benefit; however, larger prospective studies are necessary to elucidate this relationship further.
Topics: Child; Humans; Infant, Newborn; Male; Infant; Stenosis, Pulmonary Vein; Constriction, Pathologic; Retrospective Studies; Enterocolitis, Necrotizing; Prospective Studies; Pulmonary Veins; Risk Factors; Scimitar Syndrome; Univentricular Heart; Treatment Outcome
PubMed: 37422845
DOI: 10.1007/s00246-023-03214-w -
The Journal of Thoracic and... Feb 2022
Topics: Heterotaxy Syndrome; Humans; Pulmonary Veins; Scimitar Syndrome
PubMed: 34218928
DOI: 10.1016/j.jtcvs.2021.04.031 -
Journal of Cardiovascular... Sep 2020
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Long QT Syndrome; Pulmonary Veins
PubMed: 32557959
DOI: 10.1111/jce.14622 -
The Journal of Thoracic and... Feb 2022
Topics: Constriction, Pathologic; Humans; Pulmonary Veins; Recurrence
PubMed: 33933258
DOI: 10.1016/j.jtcvs.2021.03.094 -
Current Cardiology Reviews 2022Atrial Fibrillation (AF) is the most common form of electrical disturbance of the heart and contributes to significant patient morbidity and mortality. With a better...
Atrial Fibrillation (AF) is the most common form of electrical disturbance of the heart and contributes to significant patient morbidity and mortality. With a better understanding of the mechanisms of atrial fibrillation and improvements in mapping and ablation technologies, ablation has become a preferred therapy for patients with symptomatic AF. Pulmonary Vein Isolation (PVI) is the cornerstone for AF ablation therapy, but particularly in patients with AF occurring for longer than 7 days (persistent AF), identifying clinically significant nonpulmonary vein targets and achieving durability of ablation lesions remains an important challenge.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 34325644
DOI: 10.2174/1573403X17666210729101752 -
The International Journal of... Apr 2021
Topics: Humans; Predictive Value of Tests; Pulmonary Circulation; Pulmonary Embolism; Pulmonary Veins; Venous Thrombosis
PubMed: 33151512
DOI: 10.1007/s10554-020-02096-w -
Journal of Cardiovascular... Feb 2022
Topics: Catheter Ablation; Humans; Pulmonary Veins
PubMed: 34910351
DOI: 10.1111/jce.15320 -
Circulation. Cardiovascular... Jun 2022
Topics: Heart Defects, Congenital; Humans; Pulmonary Atresia; Pulmonary Veins; Treatment Outcome
PubMed: 35727879
DOI: 10.1161/CIRCINTERVENTIONS.122.012172 -
Pulmonary vein stenosis after HotBalloon pulmonary vein isolation of paroxysmal atrial fibrillation.Heart and Vessels Nov 2021HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary...
HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary vein (PV) stenosis remains a concern. The influence of longer application duration on PV stenosis has not yet been systematically evaluated. All patients who underwent first HBPVI of PAF with pre- and post-ablation computed tomography (CT) were included. We used single-shot technique with application duration of 180 s in the RSPV, 180-240 s in the LSPV, and 120 s in the lower PV procedures. PV stenosis was analyzed using CT and categorized as moderate (50-70%), and severe (> 70%) reduction in PV diameter. We analyzed imaging of the PV anatomy before ablation and during follow-up in 84 patients. Among them, 7 (8.3%) showed moderate stenosis, and 3 (3.6%) had severe stenosis including one total occlusion patient. All severe stenosis and total occlusion occurred in RSPV and LSPV procedures with longer application duration. No severe stenosis nor total PV occlusion occurred in inferior PV procedures with shorter application duration. The incidence of PV stenosis ≥ 50% or total PV occlusion was significantly lower in inferior PV than RSPV and LSPV procedures (0.6%, 6.0%, 8.0%, p = 0.01, respectively). All cases of PV stenosis including total PV occlusion patients were asymptomatic. No intervention for PV stenosis was performed. The risk of PV stenosis in HBPVI was rare in lower PV procedure with shorter application duration. An application duration setting of 120 s in lower PV procedure might be effective to prevent PV stenosis.
Topics: Atrial Fibrillation; Catheter Ablation; Constriction, Pathologic; Humans; Pulmonary Veins; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 33929574
DOI: 10.1007/s00380-021-01862-7 -
Circulation. Cardiovascular Imaging Nov 2022Multi-modality imaging plays critical roles during and after procedures associated with atrial fibrillation. Transesophageal echocardiography is an invaluable tool for... (Review)
Review
Multi-modality imaging plays critical roles during and after procedures associated with atrial fibrillation. Transesophageal echocardiography is an invaluable tool for left atrial appendage occlusion during the procedure and at follow-up. Both cardiac computed tomography and cardiac magnetic resonance contribute to postprocedural evaluation of pulmonary vein isolation ablation. The present review is the second of a 2-part series where we discuss the roles of cardiac imaging in the evaluation and management of patients with atrial fibrillation, focusing on intraprocedural and postprocedural assessment, including the clinical evidence and outcomes data supporting this future applications.
Topics: Humans; Atrial Fibrillation; Atrial Appendage; Pulmonary Veins; Multimodal Imaging; Echocardiography, Transesophageal; Catheter Ablation; Treatment Outcome
PubMed: 36378776
DOI: 10.1161/CIRCIMAGING.122.014804