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Kalustian AB, Brlecic PE, Gowda ST, Stapleton GE, Khan A, Eilers LF, Birla R, Imamura M, Qureshi AM, Caldarone CA, Bansal M. Hybrid Interventions for Pulmonary Vein Stenosis: Leveraging Intraoperative Endovascular Adjuncts in Challenging Clinical Scenarios. World J Pediatr Congenit Heart Surg 2024:21501351241247503. [PMID: 38780412 DOI: 10.1177/21501351241247503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background: Pediatric pulmonary vein stenosis (PVS) is often progressive and treatment-refractory, requiring multiple interventions. Hybrid pulmonary vein interventions (HPVIs), involving intraoperative balloon angioplasty or stent placement, leverage surgical access and customization to optimize patency while facilitating future transcatheter procedures. We review our experience with HPVI and explore potential applications of this collaborative approach. Methods: Retrospective chart review of all HPVI cases between 2009 to 2023. Results: Ten patients with primary (n = 5) or post-repair (n = 5) PVS underwent HPVI at median age of 12.7 months (range 6.6 months-9.5 years). Concurrent surgical PVS repair was performed in 7/10 cases. Hybrid pulmonary vein intervention was performed on 17 veins, 13 (76%) with prior surgical or transcatheter intervention(s). One patient underwent intraoperative balloon angioplasty of an existing stent. In total, 18 stents (9 bare metal [5-10 mm diameter], 9 drug eluting [3.5-5 mm diameter]) were placed in 16 veins. At first angiography (median 48 days [range 7 days-2.8 years] postoperatively), 8 of 16 (50%) HPVI-stented veins developed in-stent stenosis. Two patients died from progressive PVS early in the study, one prior to planned reintervention. Median time to first pulmonary vein reintervention was 86 days (10 days-2.8 years; 8/10 patients, 13/17 veins). At median survivor follow-up of 2.2 years (2.3 months-13.1 years), 1 of 11 surviving HPVI veins were completely occluded. Conclusions: Hybrid pulmonary vein intervention represents a viable adjunct to existing PVS therapies, with promising flexibility to address limitations of surgical and transcatheter modalities. Reintervention is anticipated, necessitating evaluation of long-term benefits and durability as utilization increases.
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Affiliation(s)
- Alyssa B Kalustian
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Paige E Brlecic
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Srinath T Gowda
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Gary E Stapleton
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Asra Khan
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay F Eilers
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Ravi Birla
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher A Caldarone
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Manish Bansal
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
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Mohammad Nijres B, Carr K, Aldoss O. A novel approach to place an adult-size stent to treat coarctation of the aorta using small introducers: "Nijres technique". Cardiol Young 2023; 33:2395-2401. [PMID: 37232082 DOI: 10.1017/s1047951123001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aortic arch stent placement in young children is a medical dilemma. This is attributed to the critical lack of commercially available stents that can be delivered through small sheaths and yet have the potential to be dilated to the adult-size aorta. Here in, we describe an innovative first-in-human technique that allows for overcoming the aforementioned challenges. A Palmaz Genesis XD stent was placed to treat coarctation of the aorta in two young children through small-bore sheaths.
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Affiliation(s)
- Bassel Mohammad Nijres
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Kaitlin Carr
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Osamah Aldoss
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
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Brown N, Bhatt H, Salunke A, Chinnakotla S, Qureshi AM, Aggarwal V. Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis. Liver Int 2022; 42:879-883. [PMID: 35129262 DOI: 10.1111/liv.15190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/13/2023]
Abstract
Portal hypertension because of liver cirrhosis is a significant cause of morbidity and mortality. Treatment options in these patients include liver transplant, symptomatic treatment of oesophageal varices via endoscopic treatment and symptomatic management of ascites. Portosystemic shunt creation can be challenging in newborns and infants. We present a newborn with Trisomy 21, severe portal hypertension secondary to neonatal cirrhosis, oesophageal varices and upper GI bleeding, severe ascites refractory to medical management who underwent ductus venosus stenting as a palliative procedure. He demonstrated remarkable clinical improvement with no subsequent upper GI bleed and resolution of ascites till his last follow-up at 12 months of age. To the best of our knowledge, stenting of the patent ductus venosus to create a portosystemic shunt to relieve portal hypertension has not been reported in English literature.
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Affiliation(s)
- Nicholas Brown
- Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Heli Bhatt
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amrita Salunke
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Srinath Chinnakotla
- Division of Transplant Surgery, Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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Webb MK, Justino H. Shortening of Palmaz Genesis XD stents by longitudinal compression in pediatric patients with pulmonary vein stenosis: Bench-testing and case series. Catheter Cardiovasc Interv 2021; 99:116-120. [PMID: 34687135 DOI: 10.1002/ccd.29984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/07/2022]
Abstract
The Palmaz Genesis XD stents (Cordis®, Cardinal Health, Dublin, OH) are an ideal option for stenting vessels in pediatric patients due to their ability to be re-dilated to large diameters to accompany children's somatic growth. Unfortunately, their length limits their utility for pulmonary vein stenting in small children, due to the risk of protrusion into the left atrium or into distal pulmonary vein branches. We describe a stent shortening technique by longitudinally compressing them prior to deployment, which may enhance their applicability in pediatric pulmonary vein stenosis.
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Affiliation(s)
- Melissa K Webb
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Henri Justino
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Rady Children's Hospital, San Diego, California, USA
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Hiremath G, Qureshi AM, Meadows J, Aggarwal V. Treatment approach to unilateral branch pulmonary artery stenosis. Trends Cardiovasc Med 2020; 31:179-184. [PMID: 32081565 DOI: 10.1016/j.tcm.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Abstract
Unilateral proximal pulmonary artery stenosis is often seen in the setting of postoperative congenital heart disease. Accurate assessment of the hemodynamic significance of such a lesion is important so as to determine "When to intervene?" A thorough evaluation should include symptom assessment, anatomical assessment through detailed imaging, functional assessment using differential pulmonary blood flow measurement and cardiopulmonary exercise testing. Symptoms of exertional dyspnea or intolerance, decreased pulmonary blood flow to stenosed lung, and abnormal exertional performance would be factors to pursue therapy in the setting of significant anatomical narrowing. Safe and effective therapy can be offered through transcatheter or surgical techniques and has been shown to improve exertional performance.
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Affiliation(s)
- Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA.
| | - Athar M Qureshi
- The Lillie Frank Abercrombie section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffery Meadows
- Department of Pediatrics, UCSF Benioff Children's Hospital and the University of California, San Francisco, San Francisco, CA 94118, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA
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Khan A, Qureshi AM, Justino H. Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood. Catheter Cardiovasc Interv 2019; 94:233-242. [DOI: 10.1002/ccd.28328] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Asra Khan
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
| | - Athar M. Qureshi
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
| | - Henri Justino
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
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