1
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Plut D, Bauer M, Mikić A, Winant AJ, Park H, Lee EY. Pediatric Congenital Lung Malformations: Contemporary Perspectives on Imaging Characteristics. Semin Roentgenol 2024; 59:249-266. [PMID: 38997180 DOI: 10.1053/j.ro.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Matthew Bauer
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Aleksandra Mikić
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Halley Park
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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2
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Critchfield DR, Chamberlain RC, Turek JW, Fleming GA. Hybrid approach to pulmonary vein stenting after Fontan palliation. Catheter Cardiovasc Interv 2023; 102:1095-1100. [PMID: 37681395 DOI: 10.1002/ccd.30831] [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: 01/08/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
Pulmonary vein stenosis is poorly tolerated in patients who have undergone Fontan palliation and typically requires surgical or transcatheter intervention. Percutaneous transcatheter approaches to intervention can be technically difficult due to challenging anatomy. A hybrid per-atrial transcatheter approach for stenting pulmonary veins provides a direct approach to the pulmonary veins and has the potential to improve safety and efficacy of this complex intervention. We describe our experience with hybrid per-atrial pulmonary vein stenting in three patients with pulmonary vein stenosis following Fontan palliation.
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Affiliation(s)
- Daniel R Critchfield
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Reid C Chamberlain
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph W Turek
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gregory A Fleming
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
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3
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Romberg EK, Stanescu AL, Bhutta ST, Otto RK, Ferguson MR. Computed tomography of pulmonary veins: review of congenital and acquired pathologies. Pediatr Radiol 2022; 52:2510-2528. [PMID: 34734315 DOI: 10.1007/s00247-021-05208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
Newer-generation CT scanners with ultrawide detectors or dual sources offer millisecond image acquisition times and significantly decreased radiation doses compared to historical cardiac CT and CT angiography. This technology is capable of nearly freezing cardiac and respiratory motion. As a result, CT is increasingly used for diagnosing and monitoring cardiac and vascular abnormalities in the pediatric population. CT is particularly useful in the setting of pulmonary vein evaluation because it offers evaluation of the entire pulmonary venous system and lung parenchyma. In this article we review a spectrum of congenital and acquired pulmonary venous abnormalities, including potential etiologies, CT imaging findings and important factors of preoperative planning. In addition, we discuss optimization of CT techniques for evaluating the pulmonary veins.
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Affiliation(s)
- Erin K Romberg
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - A Luana Stanescu
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sadaf T Bhutta
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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4
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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5
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Wang G, Zhou G, Wang J, Wang H, Feng Z. Window anastomosis technique for repair of supracardiac total anomalous pulmonary venous connection in infants. J Card Surg 2022; 37:3988-3990. [PMID: 35989528 DOI: 10.1111/jocs.16871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
Outcomes of operations for total anomalous pulmonary venous connection (TAPVC) have improved. However, postoperative pulmonary venous obstruction remains the most significant complication with high morbidity and mortality. We introduce a window anastomosis technique for repair of supracardiac TAPVC in infants. The mainstay of the surgical technique is to resect the anterior wall of the pulmonary vein confluence and part of the posterior wall of the left atrium to form a large and undistorted "window to window" anastomosis.
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Affiliation(s)
- Gang Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Gengxu Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Jieqiong Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Hui Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Zhichun Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatrics, The Seventh Medical Center of the PLA General Hospital, Beijing, China
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6
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V B, Hote MP. Role of 3D reconstructed images in primary pulmonary vein stenosis. Indian J Thorac Cardiovasc Surg 2021; 37:599-602. [PMID: 34511774 DOI: 10.1007/s12055-021-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022] Open
Abstract
Primary pulmonary vein stenosis (PPVS) is a rare congenital cardiac anomaly. The surgical management of PPVS requires anatomical delineation of pulmonary venous drainage along with exact localization of the stenosis. Since echocardiography cannot visualize the whole length of pulmonary veins (PV), computed tomography (CT) pulmonary venography becomes necessary. Three-dimensional (3D) reconstruction helps in planning PV augmentation and for prognostication. Here, we present 3D reconstructed CT pulmonary venography images of a 3-month-old child who presented to us with PPVS.
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Affiliation(s)
- Bharath V
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Milind Padmakar Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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7
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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect. CHILDREN-BASEL 2021; 8:children8080667. [PMID: 34438558 PMCID: PMC8394993 DOI: 10.3390/children8080667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023]
Abstract
Purpose: To retrospectively investigate the extravascular thoracic MDCT angiography findings of pulmonary vein stenosis (PVS) in children with a cardiac septal defect. Materials and Methods: Pediatric patients (age ≤ 18 years) with cardiac septal defect and PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from April 2009 to April 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in: (1) lung and airway (ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis); (2) pleura (pleural thickening, pleural effusion, and pneumothorax); and (3) mediastinum (mass and lymphadenopathy). Interobserver agreement between the two independent pediatric radiology reviewers was evaluated with kappa statistics. Results: The final study group consisted of 20 thoracic MDCT angiography studies from 20 consecutive individual pediatric patients (13 males (65%) and 7 females (35%); mean age: 7.5 months; SD: 12.7; range: 2 days to 7 months) with cardiac septal defect and PVS. The characteristic extravascular thoracic MDCT angiography findings were GGO (18/20; 90%), septal thickening (9/20; 45%), pleural thickening (16/20; 80%), and ill-defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (9/20; 45%) following the contours of PVS in the mediastinum. There was a high interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: PVS in children with a cardiac septal defect has a characteristic extravascular thoracic MDCT angiography finding. In the lungs and pleura, GGO, septal thickening, and pleural thickening are frequently seen in children with cardiac septal defect and PVS. In the mediastinum, a mildly heterogeneously enhancing, non-calcified soft tissue mass in the distribution of PVS in the mediastinum is seen in close to half of the pediatric patients with cardiac septal defect and PVS.
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8
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Jadcherla AV, Backes CH, Cua CL, Smith CV, Levy PT, Ball MK. Primary Pulmonary Vein Stenosis: A New Look at a Rare but Challenging Disease. Neoreviews 2021; 22:e296-e308. [PMID: 33931475 DOI: 10.1542/neo.22-5-e296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Primary pulmonary vein stenosis (PPVS) represents a rare but emerging, often progressive heterogeneous disease with high morbidity and mortality in the pediatric population. Although our understanding of PPVS disease has improved markedly in recent years, much remains unknown regarding disease pathogenesis, distinct disease phenotypes, and patient- and disease-related risk factors driving the unrelenting disease progression characteristic of PPVS. In the pediatric population, risk factors identified in the development of PPVS include an underlying congenital heart disease, prematurity and associated conditions, and an underlying genetic or congenital syndrome. Continued improvement in the survival of high-risk populations, coupled with ongoing advances in general PPVS awareness and diagnostic imaging technologies suggest that PPVS will be an increasingly prevalent disease affecting pediatric populations in the years to come. However, significant challenges persist in both the diagnosis and management of PPVS. Standardized definitions and risk stratification for PPVS are lacking. Furthermore, evidence-based guidelines for screening, monitoring, and treatment remain to be established. Given these limitations, significant practice variation in management approaches has emerged across centers, and contemporary outcomes for patients affected by PPVS remain guarded. To improve care and outcomes for PPVS patients, the development and implementation of universal definitions for disease and severity, as well as evidence-based guidelines for screening, monitoring, cardiorespiratory care, and indications for surgical intervention will be critical. In addition, collaboration across institutions will be paramount in the creation of regionalized referral centers as well as a comprehensive patient registry for those requiring pulmonary vein stenosis.
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Affiliation(s)
- Aditya V Jadcherla
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Carl H Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Clifford L Cua
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Molly K Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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9
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Matsuzaki Y, Wiet MG, Boe BA, Shinoka T. The Real Need for Regenerative Medicine in the Future of Congenital Heart Disease Treatment. Biomedicines 2021; 9:478. [PMID: 33925558 PMCID: PMC8145070 DOI: 10.3390/biomedicines9050478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
Bioabsorbable materials made from polymeric compounds have been used in many fields of regenerative medicine to promote tissue regeneration. These materials replace autologous tissue and, due to their growth potential, make excellent substitutes for cardiovascular applications in the treatment of congenital heart disease. However, there remains a sizable gap between their theoretical advantages and actual clinical application within pediatric cardiovascular surgery. This review will focus on four areas of regenerative medicine in which bioabsorbable materials have the potential to alleviate the burden where current treatment options have been unable to within the field of pediatric cardiovascular surgery. These four areas include tissue-engineered pulmonary valves, tissue-engineered patches, regenerative medicine options for treatment of pulmonary vein stenosis and tissue-engineered vascular grafts. We will discuss the research and development of biocompatible materials reported to date, the evaluation of materials in vitro, and the results of studies that have progressed to clinical trials.
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Affiliation(s)
- Yuichi Matsuzaki
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Matthew G. Wiet
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Brian A. Boe
- Department of Cardiology, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA;
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA
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10
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Clinical Outcomes Predictors and Surgical Management of Primary Pulmonary Vein Stenosis. Ann Thorac Surg 2021; 113:1239-1247. [PMID: 33745903 DOI: 10.1016/j.athoracsur.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgical outcomes for primary pulmonary vein stenosis (PPVS) remain unfavorable, and risk factors are still poorly understood. The purpose of this study is to evaluate outcomes and risk factors after PPVS repair. METHODS Forty patients with PPVS undergoing surgical repair in Fuwai Hospital from 2010 to 2020 were included retrospectively. Adverse outcomes included mortality, pulmonary vein (PV) restenosis and reintervention. A univariate and multivariate risk analysis was performed to determine risk factors. RESULTS The mean follow-up duration was 37.5 ± 31.5 months. Sutureless technique was performed in 7 patients (17.5%), endovenectomy in 9 patients (22.5%), and patch venoplasty in 24 patients (60%). Bilateral PV involvement was documented in 12 patients (30%). Overall mortality, PV reintervention, and restenosis occurred in 15%, 12.5%, and 25% of patients, respectively. Freedom from overall mortality, PV reintervention, and restenosis at 5 years was 85%±6.3%, 88.9%±5.2%, and 65.1%±13.2%, respectively. Multivariate analysis revealed that bilateral PV involvement was an independent risk factor for mortality or PV reintervention (hazard ratio, 10.4; 95% confident interval, 1.9-56; p = 0.006), and involvement of left inferior PV was an independent risk factor for postoperative restenosis of left inferior PV (hazard ratio, 13.1; confident interval, 2.2-76.8; p = 0.004). CONCLUSIONS Surgical treatment for PPVS remains a challenging issue with imperfect prognosis. Therefore, it is right and appropriate to take close surveillance on mild or moderate stenosis on a single pulmonary vein. Bilateral and left inferior pulmonary vein involvement are independent risk factors for adverse outcomes.
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11
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Rubens-Figueroa JD, Bobadilla-Chávez JJ, Solórzano-Morales SA. Congenital pulmonary vein stenosis and bronchopulmonary vascular malformation. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:355-360. [PMID: 33725717 PMCID: PMC8351654 DOI: 10.24875/acm.20000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
The objective is demonstrate the diagnostic process and evolution of a patient with a diagnosis of congenital pulmonary vein stenosis and broncho-pulmonary vascular malformation. One year old female patient with repeated bronchopneumonia, acrocyanosis, split S2, cardiomegaly, pulmonary hypertension, with a clinical diagnosis of atrial septal defect. The echocardiogram demonstrated left sided vein pulmonary stenosis. The cardiac catheterization demonstrated arterial-venous fistulas apical on the right lung. Magnetic Resonance image and angiography showed an aberrant arterial vessel parallel to the abdominal aorta which flow the right pulmonary lobe. The cardiac tomography angiography reported confluence of right-sided pulmonary veins. A lobectomy is performed. Patient died in post-operative due to massive pulmonary hemorrhaging. This is the first patient mentioned in written literature with pulmonary vein stenosis associated with pulmonary sequestration, with normal venous connection. Echocardiography represents the specific standard study ideal for initial diagnostic for patients with pulmonary vein stenosis.
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12
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Humpl T, Fineman J, Qureshi AM. The many faces and outcomes of pulmonary vein stenosis in early childhood. Pediatr Pulmonol 2021; 56:649-655. [PMID: 32506838 DOI: 10.1002/ppul.24848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022]
Abstract
Pulmonary vein stenosis is a rare and poorly understood condition causing obstruction of the large pulmonary veins and of blood flow from the lungs to the left atrium. This results in elevated pulmonary venous pressure and pulmonary edema, pulmonary hypertension, potentially cardiac failure, and death. Clinical signs of the disease include failure to thrive, increasingly severe dyspnea, hemoptysis, respiratory difficulty, recurrent respiratory tract infections/pneumonia, cyanosis, and subcostal retractions. On chest radiograph, the most frequent finding is increased interstitial, ground-glass and/or reticular opacity. Transthoracic echocardiography with pulsed Doppler delineates the stenosis, magnetic resonance imaging and multislice computerized tomography are used for further evaluation. Interventional cardiac catherization, surgical techniques, and medical therapies have been used with varying success as treatment options.
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Affiliation(s)
- Tilman Humpl
- Division of Pediatric Intensive Care, University Children's Hospital Berne, Inselspital, Berne, Switzerland
| | - Jeffrey Fineman
- Department of Pediatrics, Pediatric Critical Care University of California, San Francisco, California
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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13
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Carriço F, Gurioli C, Piciucchi S, Dubini A, Tomassetti S, Poletti V. Pulmonary vein stenosis mimicking interstitial lung disease. Pulmonology 2020; 27:584-589. [PMID: 32571674 DOI: 10.1016/j.pulmoe.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022] Open
Abstract
Pulmonary vein stenosis (PVS) is a rare condition, often difficult to diagnose and associated with poor prognosis at advanced stages. Lung parenchymal abnormalities are indirect evidence of PVS and can manifest as multifocal opacities, nodular lesions, unilateral effusions, and interstitial septal thickening. These can lead to erroneous diagnoses of airway disease, pneumonia, malignancy or interstitial lung disease. This review summarizes the current literature about the approach, evaluation and management of these patients. Our case report demonstrates that PVS is an under-recognized complication of cardiovascular surgery and should be considered in all patients presenting with respiratory symptoms after a cardiac procedure.
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Affiliation(s)
- Filipa Carriço
- Pulmonology Department, Sousa Martins Hospital, Guarda, Portugal
| | - Christian Gurioli
- Department of Diseases of the Thorax, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Radiology Department, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Alessandra Dubini
- Pathology Department, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Sara Tomassetti
- Department of Diseases of the Thorax, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy; Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
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14
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Management outcomes of primary pulmonary vein stenosis. J Thorac Cardiovasc Surg 2020; 159:1029-1036.e1. [DOI: 10.1016/j.jtcvs.2019.08.105] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 01/07/2023]
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15
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Li YJ, Pan X, Wang C, He B. Stent implantation for severe pulmonary vein stenosis or occlusion secondary to atrial fibrillation ablation. Int J Cardiol 2019; 301:85-89. [PMID: 31813682 DOI: 10.1016/j.ijcard.2019.11.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Catheter interventional treatment of pulmonary vein stenosis or occlusion (PVS/O) following radiofrequency ablation (RFA) for atrial fibrillation (AF) remains a challenging field due to lacking randomized data and there are limited data about stenting. METHODS All patients at our center who underwent pulmonary vein stenosis (PVS) stenting for PVS/O induced by RFA were retrospectively assessed. Clinical presentation, anatomic site of stenosis and hemodynamic information, as well as follow-up data, were collected and analyzed. RESULTS From January 2010 to June 2018, 56 patients with PVS/O secondary to RFA were treated with 113 stents. Procedural success rate was 95.8%. Pressure gradients significantly reduced (p < 0.001) and vessel caliber markedly increased (p < 0.001) in all the stenotic sites, with immediate symptoms significantly improved. The overall in-stent restenosis (ISR) rate was 21.8% after a median follow-up period of 26 months (interquartile range: 16 to 35.5 months). The incidence of ISR was higher in patients treated with stent diameter ≤ 8 mm than those with stent diameter >8 mm (HR: 3.91; 95% CI 1.74-8.81; p = 0.001). CONCLUSIONS PVS stenting is a safe and effective procedure for PVS/O secondary to RFA. Long-term patency and good clinical outcomes are gained after bigger-diameter stent implantation.
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Affiliation(s)
- Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Cheng Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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16
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Nasr VG, Callahan R, Wichner Z, Odegard KC, DiNardo JA. Intraluminal Pulmonary Vein Stenosis in Children. Anesth Analg 2019; 129:27-40. [DOI: 10.1213/ane.0000000000003924] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Halpern AL, Weyant MJ. Video-Assisted Thoracoscopic Pneumonectomy for Complications of Congenital Pulmonary Venous Stenosis. Ann Thorac Surg 2019; 108:e357-e359. [PMID: 31158352 DOI: 10.1016/j.athoracsur.2019.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 11/25/2022]
Abstract
Congenital pulmonary venous stenosis is an uncommon congenital heart defect and is a consequence of failed incorporation of the common right or left pulmonary vein into the left atrium during embryologic development. Clinical manifestations include progressive exertional dyspnea, cough, chest pain, and hemoptysis. In this report, we describe a 37-year-old woman with known congenital unilateral pulmonary venous stenosis and a unilateral hypoplastic right pulmonary artery who presented with recurrent episodes of hemoptysis, requiring multiple catheter-based interventions, and symptomatic pleural effusions, requiring multiple large-volume thoracenteses. The patient underwent successful video-assisted thoracoscopic pneumonectomy with resolution of symptoms.
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Affiliation(s)
- Alison L Halpern
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Aurora, Colorado
| | - Michael J Weyant
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Aurora, Colorado.
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18
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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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19
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Kalfa D, Belli E, Bacha E, Lambert V, di Carlo D, Kostolny M, Nosal M, Horer J, Salminen J, Rubay J, Yemets I, Hazekamp M, Maruszewski B, Sarris G, Berggren H, Ebels T, Baser O, Lacour-Gayet F. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg 2018; 156:278-286. [DOI: 10.1016/j.jtcvs.2018.02.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
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20
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Backes CH, Nealon E, Armstrong AK, Cua CL, Mitchell C, Krishnan U, Vanderlaan RD, Song MK, Viola N, Smith CV, McConnell PI, Rivera BK, Bridge J. Pulmonary Vein Stenosis in Infants: A Systematic Review, Meta-Analysis, and Meta-Regression. J Pediatr 2018; 198:36-45.e3. [PMID: 29650415 DOI: 10.1016/j.jpeds.2018.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/08/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To quantify outcomes of infants (<1 year of age) diagnosed with pulmonary vein stenosis (PVS). STUDY DESIGN MEDLINE (PubMed), Scopus, and Web of Science were searched through February 1, 2017, with no language restrictions. Publications including infants diagnosed with primary PVS, defined as the absence of preceding intervention(s), were considered. The study was performed according to Meta-analysis of Observational Studies in Epidemiology guidelines, the Systematic Reviews, and Meta-Analysis checklist, and registered prospectively. The quality of selected reports was critically examined. Data extraction was independently performed by multiple observers with outcomes agreed upon a priori. Data were pooled using an inverse variance heterogeneity model with incidence of mortality the primary outcome of interest. RESULTS Forty-eight studies of 185 infants were included. Studies were highly diverse with regards to the participants, interventions, and outcomes reported. The median (range) age at diagnosis was 5.0 (0.1-11.6) months. Pooled mortality was 58.5% (95% CI 49.8%-67.0%, I2 = 21.4%). We observed greater mortality incidence among infants with 3 or 4 vein stenoses than in those with 1 or 2 vein stenoses (83.3% vs 36.1%; P < .01). We observed greater mortality among infants with bilateral than unilateral disease (78.7% vs 26.0%; P < .01). CONCLUSIONS Studies of primary PVS during infancy are highly variable in their methodological quality and estimates of clinical outcomes; therefore, estimates of prognosis remain uncertain. Multicenter, interdisciplinary collaborations, including alignment of key outcome measurements, are needed to answer questions beyond the scope of available data.
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Affiliation(s)
- Carl H Backes
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH; Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
| | - Erin Nealon
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Aimee K Armstrong
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Courtney Mitchell
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Usha Krishnan
- Department of Pediatric Cardiology, Columbia University, New York, NY
| | - Rachel D Vanderlaan
- Division of Cardiac Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Nicola Viola
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Southampton, Southampton, United Kingdom; Department of Cardiothoracic Surgery, Children's Hospital of Southampton, Southampton, United Kingdom
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | - Patrick I McConnell
- Department of Surgery, The Ohio State University, College of Medicine, Columbus, OH; Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH; Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Jeffrey Bridge
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH
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21
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Ochiai Y, Ando Y, Tokunaga S, Muneuchi J. Sutureless pericardial marsupialization for the repair of congenital right pulmonary veins atresia. Interact Cardiovasc Thorac Surg 2018; 27:151-152. [PMID: 29432561 DOI: 10.1093/icvts/ivy024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022] Open
Abstract
We present a very rare case of isolated right pulmonary veins atresia in a 4-year-old girl. As the presence of a pulsatile blind pulmonary venous confluence adjacent to the left atrium was demonstrated by preoperative right pulmonary arterial wedge angiography, we applied sutureless pericardial marsupialization for the repair of right pulmonary veins atresia. She is currently 8 years old without pulmonary veins stenosis.
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Affiliation(s)
- Yoshie Ochiai
- Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu City, Japan
| | - Yusuke Ando
- Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu City, Japan
| | - Shigehiko Tokunaga
- Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu City, Japan
| | - Jun Muneuchi
- Department of Pediatric Cardiology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu City, Japan
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22
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Salve GG, Jain SA, Shivaprakash K. Key technical steps in dual-pathway repair of congenital pulmonary vein stenosis. Asian Cardiovasc Thorac Ann 2018; 26:498-501. [PMID: 29860897 DOI: 10.1177/0218492318780804] [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: 11/16/2022]
Abstract
We present the case of a 2-year-old girl with congenital stenosis of the left inferior pulmonary vein associated with a large perimembranous ventricular septal defect. The child underwent repair of the left inferior pulmonary vein with autologous left atrial appendage as a pedicled tube, followed by closure of the ventricular septal defect. Important technical steps to minimize the restenosis rate are highlighted.
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Affiliation(s)
- Gananjay Gopalrao Salve
- Department of Pediatric Cardiac Sciences, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Shreepal Ambalal Jain
- Department of Pediatric Cardiac Sciences, Sir HN Reliance Foundation Hospital, Mumbai, India
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23
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Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary Veins. Radiographics 2018; 37:1928-1954. [PMID: 29131765 DOI: 10.1148/rg.2017170050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Cameron Hassani
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Farhood Saremi
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
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24
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Tremblay C, Yoo SJ, Mertens L, Seed M, Jacques F, Slorach C, Vanderlaan R, Greenway S, Caldarone C, Coles J, Grosse-Wortmann L. Sutureless Versus Conventional Pulmonary Vein Repair: A Magnetic Resonance Pilot Study. Ann Thorac Surg 2018; 105:1248-1254. [PMID: 29482852 DOI: 10.1016/j.athoracsur.2017.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two different surgical techniques are used to repair anomalous pulmonary venous connection or pulmonary vein (PV) stenosis: the classic repair (CR) and the sutureless repair (SR). The purpose of this study was to compare the prevalence of PV stenosis between the two surgical approaches. METHODS Patients were prospectively recruited irrespective of symptoms or previous imaging findings. Cardiac magnetic resonance imaging and echocardiography were performed in a blinded fashion on the same day. RESULTS Twenty-five patients (13 male) after PV repair completed the study. Twelve patients had undergone CR and 13 SR (in 1 patient as a reoperation after CR). The median age at operation was 2 months (range: 1 day to 5 years) and was similar for both groups; the median age at the time of cardiac magnetic resonance was 9 years (range: 6 to 17 years) and 9 years (range: 6 to 14 years) for the CR and SR, respectively. Four patients had PV stenosis. All 4 patients had had total anomalous pulmonary venous connection, 1 patient had undergone repair with the CR and 2 with a primary SR; 1 patient had first undergone a CR, followed by a SR for stenosis. Echocardiography provided complete visualization of all PVs in only 11 patients (44%). Notable stenosis of at least one PV was missed by echocardiography in 2 patients. CONCLUSIONS This pilot study indicates that not only CR but also SR may be burdened by a risk of postoperative PV stenosis. Magnetic resonance imaging should be used routinely for the postoperative monitoring for the development of PV obstruction.
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Affiliation(s)
- Cornelia Tremblay
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Frederic Jacques
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Vanderlaan
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven Greenway
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Coles
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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25
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Jain S, Bachani NS, Pinto RJ, Dalvi BV. Dual pathology causing severe pulmonary hypertension following surgical repair of total anomalous pulmonary venous connection: Successful outcome following serial transcatheter interventions. Ann Pediatr Cardiol 2018; 11:79-82. [PMID: 29440835 PMCID: PMC5803982 DOI: 10.4103/apc.apc_1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Surgical repair of total anomalous pulmonary venous connection (TAPVC) can be complicated by the development of pulmonary venous stenosis later on. In addition, the vertical vein, if left unligated, can remain patent and lead to hemodynamically significant left to right shunting. We report an infant who required transcatheter correction of both these problems after surgical repair of TAPVC.
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Affiliation(s)
| | - Neeta S Bachani
- Glenmark Cardiac Center, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Robin J Pinto
- Glenmark Cardiac Center, Holy Family Hospital, Mumbai, Maharashtra, India
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26
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Tarui T, Watanabe G, Kiuchi R, Tomita S, Ohtake H, Yoshizumi K. Surgical Repair for the Treatment of Pulmonary Vein Stenosis After Radiofrequency Ablation. Ann Thorac Surg 2017; 104:e253-e254. [PMID: 28838520 DOI: 10.1016/j.athoracsur.2017.03.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
Radiofrequency ablation procedures for atrial fibrillation are occasionally associated with pulmonary vein stenosis (PVS). A common treatment for PVS is catheter intervention; however, because of the high restenosis rate, it is not suitable for young patients. The case presented herein is of a young male patient with severe bilateral PVS who underwent successful surgical pulmonary vein repair by sutureless technique. The stenotic lesions of the pulmonary veins were dissected and were covered using autologous pericardium. An enhanced computed tomographic scan revealed that all the pulmonary veins were widely patent after 6 months from the operation.
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Affiliation(s)
- Tatsuya Tarui
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan.
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ryuta Kiuchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Hiroshi Ohtake
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ko Yoshizumi
- Department of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi Jichi Medical University, Tochigi, Japan
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27
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28
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Kalfa D, Belli E, Bacha E, Lambert V, di Carlo D, Kostolny M, Salminen J, Nosal M, Poncelet A, Horer J, Berggren H, Yemets I, Hazekamp M, Maruszewski B, Sarris G, Pozzi M, Ebels T, Lacour-Gayet F. Primary Pulmonary Vein Stenosis: Outcomes, Risk Factors, and Severity Score in a Multicentric Study. Ann Thorac Surg 2017. [DOI: 10.1016/j.athoracsur.2017.03.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Persistent Oxygen Requirement beyond Prematurity: A Case of Acquired Pulmonary Vein Stenosis. Case Rep Pediatr 2017; 2017:3106871. [PMID: 28392954 PMCID: PMC5368389 DOI: 10.1155/2017/3106871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/17/2022] Open
Abstract
Acquired pulmonary vein stenosis is a rare cardiac defect and diagnosis can often be challenging, as many cases present with refractory or prolonged oxygen requirement over the expected course. Comorbid conditions can cloud this diagnosis further. Prognosis is poor for most patients. We present a case of idiopathic acquired pulmonary vein stenosis and discuss diagnostics, treatment options, and the need for further collaborative studies.
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30
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Kulik TJ, Austin ED. Pulmonary hypertension's variegated landscape: a snapshot. Pulm Circ 2017; 7:67-81. [PMID: 28680566 PMCID: PMC5448531 DOI: 10.1177/2045893216686930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/29/2016] [Indexed: 01/29/2023] Open
Abstract
The many types of pulmonary hypertension (PH) are so protean in their biological origin, histological expression, and natural history that it is difficult to create a summary picture of the disease, or to easily compare and contrast characteristics of one type of PH with another. For newcomers to the field, however, such a picture would facilitate a broad understanding of PH. In this paper, we suggest that four characteristics are fundamental to describing the nature of various types of PH, and that taken together they define a number of patterns of PH expression. These characteristics are histopathology, developmental origin, associated clinical conditions, and potential for resolution. The “snapshot” is a way to concisely display the ways that these signal characteristics intersect in select specific types of PH, and is an effort to summarize these patterns in a way that facilitates a “big picture” comprehension of this disease.
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Affiliation(s)
- Thomas J Kulik
- Department of Cardiology, Division of Cardiac Critical Care, and the Pulmonary Hypertension Program, Boston Children's Hospital, Boston, MA, USA
| | - Eric D Austin
- Vanderbilt Pediatric Pulmonary Hypertension Program, Vanderbilt Medical Center North, Nashville, TN, USA
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31
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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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32
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Pagel PS, Sethi P, Boettcher BT, Dolinski SY. A Pulmonary Venous Blood Flow Problem During Left Upper Lobectomy. J Cardiothorac Vasc Anesth 2016; 30:1156-8. [PMID: 27521974 DOI: 10.1053/j.jvca.2016.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Pawan Sethi
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Brent T Boettcher
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Sylvia Y Dolinski
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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33
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Mainzer G, Rosenthal E, Austin C, Morgan G. Hybrid Approach for Recanalization and Stenting of Acquired Pulmonary Vein Occlusion. Pediatr Cardiol 2016; 37:983-5. [PMID: 27017230 DOI: 10.1007/s00246-016-1376-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Abstract
A 5-year-old child with a Fontan circulation presented with acquired left pulmonary vein occlusion related to a previous surgical repair. We managed this lesion using a hybrid technique to perforate, dilate and stent the obstructed vessel. This approach should be considered when percutaneous access to the pulmonary veins is challenging (such as in a Fontan circulation). It also avoids the need for a high-risk redo sternotomy and cardiopulmonary bypass procedure.
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Affiliation(s)
- Gur Mainzer
- Department of Paediatric Cardiology, Evelina London Children's Hospital, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Eric Rosenthal
- Department of Paediatric Cardiology, Evelina London Children's Hospital, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Conal Austin
- Department of Paediatric Cardiac Surgery, Evelina Children's Hospital, London, UK
| | - Gareth Morgan
- Department of Paediatric Cardiology, Evelina London Children's Hospital, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
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Zhang G, Yu H, Chen L, Li Y, Liang Z. Pulmonary veins stenosis after catheter ablation of atrial fibrillation as the cause of haemoptysis: three cases and a literature review. CLINICAL RESPIRATORY JOURNAL 2016; 12:3-9. [PMID: 27216646 DOI: 10.1111/crj.12501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 04/28/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemoptysis is a common clinical symptom with a complicated aetiology. Patients usually visit pulmonologists initially and are misdiagnosed due to physician ignorance regarding the rare causes of haemoptysis. METHODS We report three cases of haemoptysis due to pulmonary vein stenosis accompanied by catheter ablation for atrial fibrillation and review the related literature. RESULTS The three patients presented haemoptysis and they all had the history of catheter ablation. They received kinds of non-invasive and invasive diagnostic and therapeutic procedures. Finally they were confirmed to have pulmonary vein stenosis by either pulmonary angiography or thorax computed tomography three-dimensional reconstructions. CONCLUSIONS Haemoptysis could be caused by pulmonary vein stenosis secondary to catheter ablation for atrial fibrillation. Doctors should be aware of this rare aetiology.
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Affiliation(s)
- Guoxin Zhang
- Department of Respiration, Tianjin Chest Hospital, Tianjin, China
| | - Hu Yu
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Liangan Chen
- Department of Respiration, Chinese PLA General Hospital, Beijing, China
| | - Yuechuan Li
- Department of Respiration, Tianjin Chest Hospital, Tianjin, China
| | - Zhixin Liang
- Department of Respiration, Chinese PLA General Hospital, Beijing, China
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Pulmonary Hypertension in the Preterm Infant with Chronic Lung Disease can be Caused by Pulmonary Vein Stenosis: A Must-Know Entity. Pediatr Cardiol 2016; 37:313-21. [PMID: 26573816 DOI: 10.1007/s00246-015-1279-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
Pulmonary hypertension (PHT) in the preterm infant is frequently due to chronic lung disease. Rarely, PHT can be caused by pulmonary vein (PV) stenosis that has been described to be associated with prematurity. This study is a retrospective analysis of all premature infants <37 weeks of gestation with PV stenosis and PHT in two French pediatric congenital cardiac centers from 1998 till 2015. Diagnosis, hemodynamics and outcome are described. Sixteen patients met the inclusion criteria. Median gestational age was 28 weeks (25 + 6-35) with a median birth weight of 842 g (585-1500). The majority of infants (87.5 %) had chronic lung disease and associated cardiac defects. Median age at diagnosis was 6.6 months (1.5-71). Fifty-six percentage (n = 9) had initially unilateral PV stenosis affecting in 89 % the left PV. Median initial invasive mean pulmonary artery pressure was 42 mmHg (25-70). Treatment options included surgical intervention (n = 6), interventional cardiac catheter (n = 3) and/or targeted therapy for pulmonary arterial hypertension (n = 5). In six patients, decision of nonintervention was taken. Global mortality was 44 %. All deaths occurred within 7 months after diagnosis regardless of chosen treatment option. Mean follow-up was 6 years (4.9 months-12 years). At last visit, all eight survivors were in stable clinical condition with five of them receiving targeted therapy for pulmonary arterial hypertension. PV stenosis is an unusual cause of PHT in the premature infant with chronic lung disease. Diagnosis is challenging since initial echocardiography can be normal and the disease is progressive. Treatment options are numerous, but prognosis remains guarded.
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Pazos-López P, García-Rodríguez C, Guitián-González A, Paredes-Galán E, Álvarez-Moure MÁDLG, Rodríguez-Álvarez M, Baz-Alonso JA, Teijeira-Fernández E, Calvo-Iglesias FE, Íñiguez-Romo A. Pulmonary vein stenosis: Etiology, diagnosis and management. World J Cardiol 2016; 8:81-8. [PMID: 26839659 PMCID: PMC4728109 DOI: 10.4330/wjc.v8.i1.81] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/05/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Pablo Pazos-López
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Cristina García-Rodríguez
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Alba Guitián-González
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Emilio Paredes-Galán
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - María Ángel De La Guarda Álvarez-Moure
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Marta Rodríguez-Álvarez
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - José Antonio Baz-Alonso
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Elvis Teijeira-Fernández
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Francisco Eugenio Calvo-Iglesias
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
| | - Andrés Íñiguez-Romo
- Pablo Pazos-López, Cristina García-Rodríguez, Alba Guitián-González, Emilio Paredes-Galán, José Antonio Baz-Alonso, Elvis Teijeira-Fernández, Francisco Eugenio Calvo-Iglesias, Andrés Íñiguez-Romo, Department of Cardiology, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, 36312 Pontevedra, Spain
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Congenital Pulmonary Vein Stenosis: Encouraging Mid-term Outcome. Pediatr Cardiol 2016; 37:125-30. [PMID: 26271471 DOI: 10.1007/s00246-015-1249-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
Congenital pulmonary vein stenosis (PVS) is a rare entity with limited outcome literature. Multiple interventional approaches have evolved including surgical and catheterization techniques. Our objective is to report our center experience and to compare short-term and mid-term outcomes among these therapeutic modalities. Retrospective study on 23 patients (n = 23) with PVS that required intervention over the last 13 years (2000-2013). Patients were divided into three groups based on type of initial intervention. Of these, 10 (43.5%) had balloon angioplasty, 3 (13.0 %) had surgical dilation, and 10 (43.5%) had surgical marsupialization. Mortality and number of re-interventions were our primary outcomes. Mean age at diagnosis was 10.9 ± 18.4 months. Mean age at initial intervention was 14.5 ± 18.0 months. Mean pre- and post-initial intervention PVS gradients were 9.2 ± 3.4 and 3.4 ± 2.2 mmHg, respectively. Mean survival time and re-intervention-free survival time were 4.8 ± 4.0 and 2.8 ± 3.4 years. No statistical significance was found between the interventions with respect to survival time (p = 0.52) and re-intervention free time (p = 0.78). High initial pre- and post-intervention gradients were significantly associated with re-intervention-free survival (p = 0.01 and p = 0.03, respectively). Patients with bilateral disease have increased mortality (p = 0.01) and decreased 5-year survival (p = 0.009) compared to patients with unilateral disease irrespective of type of intervention. No statistically significant difference in mortality or re-intervention rate was present among these different therapeutic modalities. This study has the longest follow-up so far reported in the current literature (58 months) with overall survival of 78%.
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Shi G, Zhu Z, Chen H, Zhang H, Zheng J, Liu J. Surgical repair for primary pulmonary vein stenosis: Single-institution, midterm follow-up. J Thorac Cardiovasc Surg 2015; 150:181-8. [DOI: 10.1016/j.jtcvs.2015.03.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 12/15/2022]
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Quinonez LG, Gauvreau K, Borisuk M, Ireland C, Marshall AM, Mayer JE, Jenkins KJ, Fynn-Thompson FE, Baird CW. Outcomes of surgery for young children with multivessel pulmonary vein stenosis. J Thorac Cardiovasc Surg 2015. [PMID: 26215353 DOI: 10.1016/j.jtcvs.2015.06.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We pursued a multimodality approach to the treatment of patients with pulmonary vein stenosis, incorporating sutureless surgical repair, catheter interventions, and adjunctive chemotherapy. We report our outcomes after surgery. METHODS Between January 2007 and August 2013, 49 patients with multivessel pulmonary vein stenosis underwent operations at our institution. We retrospectively reviewed data from a pulmonary vein stenosis registry and the medical records. RESULTS At the time of the index operation, the median patient age was 6 months (range, 32 days-48 months) and weight was 4.9 kg (range, 2.1-13.4 kg). Fourteen patients (28%) died during the follow-up period (median follow-up was 0.5 years [range, 0.04-4.9 years]). There were 2 deaths (4%) within 30 days. Age at repair <6 months, weight at repair <3 kg, and a preoperative right ventricular systolic pressure < ¾ systemic were found to be associated with mortality. One patient required repeat operation for recurrent stenosis. Thirty-nine patients (80%) underwent postoperative catheterizations. The median number of catheterizations per patient was 2 (range, 0-14). Twenty-nine patients (59%) underwent catheterizations with pulmonary vein intervention. The median number of catheterizations with intervention per patient was 1 (range, 0-14). There were no identifiable associations with need for or number of catheterizations with intervention. Ten patients were listed for lung transplantation: 4 patients were de-listed, 3 patients died waiting, and 3 patients underwent transplant. CONCLUSIONS Using a multimodality approach, we observed acceptable early survival after operation in patients with pulmonary vein stenosis, despite the need for catheter reinterventions. Lung transplantation remains a viable option.
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Affiliation(s)
- Luis G Quinonez
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
| | | | - Michele Borisuk
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | | | | | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
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Bonello B, Trivedi KR, Fraisse A. Multiple and aggressive pulmonary vein transcatheter interventions as bridge to transplantation in primary diffuse pulmonary vein stenosis. Catheter Cardiovasc Interv 2015; 86:E190-3. [DOI: 10.1002/ccd.25920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/26/2015] [Accepted: 03/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Béatrice Bonello
- Congenital Heart Disease Department; La Timone, University Children Hospital; Marseille France
| | - Kalyani R. Trivedi
- Biological Sciences Division; Department of Pediatrics; University of Chicago; Chicago Illinois
| | - Alain Fraisse
- Congenital Heart Disease Department; La Timone, University Children Hospital; Marseille France
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Zhu J, Ide H, Fu YY, Teichert AM, Kato H, Weisel RD, Maynes JT, Coles JG, Caldarone CA. Losartan ameliorates “upstream” pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis. J Thorac Cardiovasc Surg 2014; 148:2550-7. [DOI: 10.1016/j.jtcvs.2014.07.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
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Surgical Repair of Pulmonary Venous Stenosis: A Word of Caution. Ann Thorac Surg 2014; 98:1687-91; discussion 1691-2. [DOI: 10.1016/j.athoracsur.2014.05.082] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/30/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022]
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Thacker PG, Rao AG, Hill JG, Lee EY. Congenital Lung Anomalies in Children and Adults. Radiol Clin North Am 2014; 52:155-81. [DOI: 10.1016/j.rcl.2013.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yamashita K, Hoashi T, Kagisaki K, Kurosaki K, Shiraishi I, Yagihara T, Ichikawa H. Midterm outcomes of sutureless technique for postoperative pulmonary venous stenosis. Gen Thorac Cardiovasc Surg 2013; 62:48-52. [PMID: 23918318 DOI: 10.1007/s11748-013-0300-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The efficacy of a sutureless technique for postoperative pulmonary venous stenosis (PVS) following repair of total anomalous pulmonary venous connection (TAPVC) has been reported, though detailed clinical advantages remain unclear. We retrospectively reviewed our surgical experience, and compared outcomes between conventional procedures and a sutureless technique. METHODS For relief of postoperative PVS after TAPVC repair, five patients underwent a conventional procedure, such as orifice cutback or resection of a proliferated intima, from 1999 to 2004 (Conventional group, 4 males, median 93 days old, 3.6 kg), then seven underwent a sutureless technique (Sutureless group, 5 males, 119 days old, 3.4 kg) from 2005 to 2011. Patients with a functional single ventricle were excluded. There were no significant differences regarding patient characteristics. Follow-up examinations were completed in all patients. RESULTS The rate for cumulative survival at 5 years was 60 % in the Conventional group and 71.4 % in the Sutureless group. Re-stenosis after relief of PVS occurred in 100 % (10/10) of patients in the Conventional group and 31.6 % (6/19) of patients in the Sutureless group (p = 0.0088). For bilateral venous stenosis patients, the survival rate was 66.7 % (4/6) in the Sutureless group and 0 % (0/2) in the Conventional group (p = 0.10). Out of three patients who developed whole 4-vein stenosis, only one in the Sutureless group survived. CONCLUSIONS Although overall survival rate was similar in both groups, the Sutureless technique for postoperative PVS following TAPVC repair successfully rescued more pulmonary veins without re-stenosis than conventional procedures. Further follow-up may demonstrate therapeutic advantages.
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Affiliation(s)
- Kizuku Yamashita
- Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan
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Lung transplant is a viable treatment option for patients with congenital and acquired pulmonary vein stenosis. J Heart Lung Transplant 2013; 32:621-5. [DOI: 10.1016/j.healun.2013.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 11/20/2022] Open
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Gowda S, Bhat D, Feng Z, Chang CH, Ross RD. Pulmonary Vein Stenosis with Down Syndrome: A Rare and Frequently Fatal Cause of Pulmonary Hypertension in Infants and Children. CONGENIT HEART DIS 2013; 9:E90-7. [DOI: 10.1111/chd.12088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Srinath Gowda
- Pediatric Cardiology; The Children's Hospital of Michigan; Detroit Medical Center; Detroit Mich USA
| | - Deepti Bhat
- Pediatric Cardiology; The Children's Hospital of Michigan; Detroit Medical Center; Detroit Mich USA
| | - Zhuang Feng
- Pediatric Pathology; The Children's Hospital of Michigan; Detroit Medical Center; Detroit Mich USA
| | - Chung-Ho Chang
- Pediatric Pathology; The Children's Hospital of Michigan; Detroit Medical Center; Detroit Mich USA
| | - Robert D. Ross
- Pediatric Cardiology; The Children's Hospital of Michigan; Detroit Medical Center; Detroit Mich USA
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Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, McCarthy KP, Jones S, Shaughnessy L, Sunnegardh J, Hanseus K, Berggren H, Johansson S, Rigby ML, Keeton BR, Daubeney PE. Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction. J Thorac Cardiovasc Surg 2013; 145:1255-62. [DOI: 10.1016/j.jtcvs.2012.06.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/09/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022]
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Hörer J, Neuray C, Vogt M, Cleuziou J, Kasnar-Samprec J, Lange R, Schreiber C. What to expect after repair of total anomalous pulmonary venous connection: data from 193 patients and 2902 patient years. Eur J Cardiothorac Surg 2013; 44:800-7. [PMID: 23515167 DOI: 10.1093/ejcts/ezt129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Total anomalous pulmonary venous connection (TAPVC) occurs as isolated cases, in combination with single ventricle physiology, and may be complicated by pulmonary venous obstruction. We sought to identify potential risk factors for long-term mortality and reoperations. METHODS Data from 193 consecutive patients who had undergone repair of TAPVC between 1974 and 2011 were analysed using multivariate Cox regression. Mean follow-up time was 15.0 ± 11.0 years, 95% complete. RESULTS Survival was 82.7 ± 2.9% at 20 years. Single ventricle physiology (5.9% of the patients, P < 0.001) emerged as the only significant risk factor for mortality in multivariate analyses. Freedom from cardiac reoperation was 82.2 ± 3.3% at 20 years. Single ventricle physiology (P < 0.001) was the only risk factor for cardiac reoperations in multivariate analyses. Freedom from reoperations for pulmonary venous obstruction was 90.4 ± 2.5% at 20 years. An age at operation of ≤30 days (52.8% of the patients, P = 0.007) was the only risk factor for reoperations for pulmonary venous obstruction in univariate analyses. In patients with isolated TAPVC (n = 177), preoperative pulmonary venous obstruction (53.7% of the patients, P = 0.030) and deep hypothermic circulatory arrest (78.5% of the patients, P = 0.017) emerged as risk factors for mortality in univariate analyses. An age at operation of ≤30 days (53.7% of the patients, P = 0.022) was the only risk factor for reoperations for pulmonary venous obstruction in univariate analyses. CONCLUSIONS Survival into the third decade without reoperations is excellent in patients with isolated TAPVC without preoperative pulmonary venous obstruction, irrespective of the type of anomalous connection. In contrast, survival of patients with TAPVC and single ventricle physiology is among the poorest of all congenital heart defects. Reoperations for pulmonary venous obstruction are rare and are predominantly required in patients who were operated on as neonates. Survival may be improved by using a strategy of low-flow cardiopulmonary bypass.
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Affiliation(s)
- Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
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Wong SS, Tan JL. An Unusual Cause of Severe Pulmonary Hypertension in a Young Woman. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n2p91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Ju Le Tan
- National Heart Centre Singapore, Singapore
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Clinical Characteristics and Prognostic Factors of Primary Pulmonary Vein Stenosis or Atresia in Children. Ann Thorac Surg 2013; 95:229-34. [DOI: 10.1016/j.athoracsur.2012.08.104] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/27/2012] [Accepted: 08/31/2012] [Indexed: 11/24/2022]
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