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Butto A, O'Halloran C, Kuo J, Joong A, Hauck AL, Nugent A, Mahle W, Tannous P. De Novo and Progressive Pulmonary Vein Stenosis Following Pediatric Heart Transplantation: A Multicenter Retrospective Study. Pediatr Transplant 2024; 28:e14828. [PMID: 39030991 DOI: 10.1111/petr.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/07/2024] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is a rare condition in which neointimal proliferation leads to venous and arterial hypertension. Little is known about PVS after heart transplant (HTx) in children. We sought to describe the characteristics and outcomes of children who develop PVS after HTx. METHODS We performed a retrospective review of patients ≤18 years old who underwent HTx at two HTx centers between April 2012 and October 2023. Patients with PVS were identified via database queries. Cardiac diagnosis, PVS location and extent, and outcomes were recorded. RESULTS Over 11.5 years, 422 patients underwent HTx across both centers. Nineteen patients with PVS (10 male) were identified, 15 with de novo PVS. Sixteen had underlying congenital heart disease (CHD), two with anomalous pulmonary venous return. PVS was diagnosed at a median of 2 months (range 2 weeks to 14 years) after HTx. At time of initial diagnosis, 13 patients had one-vessel PVS. At final follow-up, 7/19 (37%) had increases in the number of vessels involved. Six patients underwent surgery, and nine patients had stent or balloon angioplasty. Two patients were treated for pulmonary hypertension following PVS diagnosis. Three patients died from right heart failure secondary to PVS. CONCLUSIONS This is the largest study to describe the characteristics of post-HTx PVS in children. PVS occurs in 4.5% of HTx, and underlying CHD is a strong risk factor. Multiple vessels can be involved and may require catheter-based or surgical intervention. Clinicians must be vigilant in monitoring the development of PVS in this population.
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Affiliation(s)
- Arene Butto
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - James Kuo
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Joong
- Lurie Children's Hospital, Chicago, Illinois, USA
| | | | - Alan Nugent
- Lurie Children's Hospital, Chicago, Illinois, USA
| | - William Mahle
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Paul Tannous
- Lurie Children's Hospital, Chicago, Illinois, USA
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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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