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The Journal of Thoracic and... Jun 2021
Topics: Child; Child, Preschool; Heart Defects, Congenital; Humans; Infant; Lung Transplantation; Pulmonary Veins; Stenosis, Pulmonary Vein
PubMed: 32763037
DOI: 10.1016/j.jtcvs.2020.05.117 -
Circulation Journal : Official Journal... Nov 2023
Topics: Humans; Stenosis, Pulmonary Vein; Pulmonary Veins; Catheter Ablation; Iatrogenic Disease; Atrial Fibrillation; Treatment Outcome; Angioplasty, Balloon
PubMed: 37380435
DOI: 10.1253/circj.CJ-23-0388 -
The Journal of Thoracic and... Jun 2022The study objective was to evaluate outcomes of pulmonary vein stenosis repair in a large single-center cohort.
OBJECTIVE
The study objective was to evaluate outcomes of pulmonary vein stenosis repair in a large single-center cohort.
METHODS
Clinical data from a pulmonary vein stenosis registry were retrospectively reviewed identifying patients who underwent pulmonary vein stenosis repair. The primary/index operation was defined as the patient's first pulmonary vein stenosis operation during the study period.
RESULTS
Between January 2007 and August 2019, 174 patients underwent pulmonary vein stenosis repair. Bilateral pulmonary vein stenosis occurred in 111 patients (64%); 71 patients (41%) had 4-vessel disease. Fifty-nine patients (34%) had primary pulmonary vein stenosis. Median age was 9 months (interquartile range, 5-27) and weight was 6.5 kg (4.7-10.2). Surgical techniques evolved and included ostial resection, unroofing, reimplantation, sutureless, modified sutureless, and a newer anatomically focused approach of pulmonary vein stenosis resection with lateralization or patch enlargement of the pulmonary vein-left atrium connection. Twenty-three patients (13%) required reoperation. Cumulative 2-year incidence of postoperative transcatheter intervention (balloon dilation ± stenting) was 64%. One-, 2-, and 5-year survivals were 71.2%, 66.8%, and 60.6%, respectively. There was no association between surgery type and reoperation rate (hazard ratio, 2.38, P = .25) or transcatheter intervention (hazard ratio, 0.97, P = .95). The anatomically focused repair was associated with decreased mortality on univariate (hazard ratio, 0.38, P = .042) and multivariable analyses (hazard ratio, 0.19, P = .014). Antiproliferative chemotherapy was also associated with decreased mortality (hazard ratio, 0.47, P = .026).
CONCLUSIONS
This large single-center surgical pulmonary vein stenosis experience demonstrates encouraging midterm results. A new anatomically focused repair strategy aims to alleviate pulmonary vein angulation to minimize turbulence and shows promising early outcomes. Continued follow-up is required to understand longer-term outcomes for this surgical approach.
Topics: Humans; Infant; Pulmonary Veins; Reoperation; Retrospective Studies; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 34801262
DOI: 10.1016/j.jtcvs.2021.10.022 -
JACC. Clinical Electrophysiology Jul 2019
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Temperature; Time Factors
PubMed: 31320007
DOI: 10.1016/j.jacep.2019.05.007 -
JACC. Cardiovascular Interventions Aug 2018
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 30139472
DOI: 10.1016/j.jcin.2018.06.010 -
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 -
The Journal of Thoracic and... Feb 2018
Topics: Pulmonary Veins
PubMed: 29153435
DOI: 10.1016/j.jtcvs.2017.09.128 -
The Journal of Thoracic and... Feb 2022
Topics: Constriction, Pathologic; Humans; Pulmonary Veins; Recurrence
PubMed: 33933258
DOI: 10.1016/j.jtcvs.2021.03.094 -
Biological & Pharmaceutical Bulletin 2013The pulmonary vein contains a myocardial layer extending from the left atrium, which is receiving attention as the source of ectopic electrical activity underlying... (Review)
Review
The pulmonary vein contains a myocardial layer extending from the left atrium, which is receiving attention as the source of ectopic electrical activity underlying atrial fibrillation. Electrophysiological and pharmacological analysis of the pulmonary vein myocardium performed in various experimental animal species have revealed characteristics such as presence of intracellular Ca(2+) oscillations and low repolarizing potency. The automaticity of the pulmonary vein myocardium is affected by various neurotransmitters, hormones and pharmacological agents. Clarification of the mechanisms and regulation of pulmonary vein automaticity would lead to the development of novel therapeutic strategies and pharmacological agents for atrial fibrillation.
Topics: Action Potentials; Animals; Calcium; Myocardium; Pulmonary Veins
PubMed: 23302630
DOI: 10.1248/bpb.b212020 -
JACC. Clinical Electrophysiology Jun 2022Thirty-eight patients had assessment of pulmonary vein occlusion with the dielectric mapping system and injection of saline as an alternative to contrast. Contrast... (Review)
Review
Thirty-eight patients had assessment of pulmonary vein occlusion with the dielectric mapping system and injection of saline as an alternative to contrast. Contrast injection was required to ascertain pulmonary vein occlusion in 31.6% (12 of 38) of subjects and 17.4% (27 of 155) of veins. No contrast was required in the last 13 subjects. In this single center study, a novel mapping-guided cryoablation approach appeared to minimize the use of contrast in pulmonary vein isolation for the treatment of atrial fibrillation.
Topics: Atrial Fibrillation; Cryosurgery; Feasibility Studies; Humans; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Treatment Outcome
PubMed: 35738857
DOI: 10.1016/j.jacep.2022.04.011