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Grosse-Wortmann L, Wald R, Valverde I, Lsangiacomo-Buechel E, Ordovas K, Raimondi F, Babu-Narayan S, Krishnamurthy R, Yim D, Rathod RH. Society for Cardiovascular Magnetic Resonance Guidelines for Reporting Cardiovascular Magnetic Resonance Examinations in Patients with Congenital Heart Disease. J Cardiovasc Magn Reson 2024:101062. [PMID: 39053855 DOI: 10.1016/j.jocmr.2024.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA.
| | - Rachel Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Israel Valverde
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada
| | | | - Karen Ordovas
- University of Washington, Department of Radiology, Seattle, WA, USA
| | - Francesca Raimondi
- Department of Pediatric and Adult Congenital Heart Diseases, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Sonya Babu-Narayan
- Royal Brompton Hospital, Department of Adult Congenital Heart Disease, London, United Kingdom
| | | | - Deane Yim
- Perth Children's Hospital, Department of Paediatric Cardiology, Perth, Australia
| | - Rahul H Rathod
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
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2
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Li D, Qiu L, Hong H, Chen H, Zhao P, Xiao Y, Zhang H, Sun Q, Ye L. A neonatal rat model of pulmonary vein stenosis. Cell Biosci 2023; 13:112. [PMID: 37337290 DOI: 10.1186/s13578-023-01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Pulmonary vein stenosis (PVS), one of the most challenging clinical problems in congenital heart disease, leads to secondary pulmonary arterial hypertension (PAH) and right ventricular (RV) hypertrophy. Due to the lack of a rodent model, the mechanisms underlying PVS and its associated secondary effects are largely unknown, and treatments are minimally successful. This study developed a neonatal rat PVS model with the aim of increasing our understanding of the mechanisms and developing possible treatments for PVS. METHODS PVS was created at postnatal day 1 (P1) by banding pulmonary veins that receive blood from the right anterior and mid lobes. The condition was confirmed using echocardiography, computed tomography (CT), gross anatomic examination, hematoxylin and eosin (H&E) staining, fibrosis staining, and immunofluorescence. Lung and RV remodeling under the condition of PVS were evaluated using H&E staining, fibrosis staining, and immunofluorescence. RESULTS At P21, echocardiography revealed a change in wave form and a decrease in pulmonary artery acceleration time-indicators of PAH-at the transpulmonary valve site in the PVS group. CT at P21 showed a decrease in pulmonary vein diameter in the PVS group. At P30 in the PVS group, gross anatomic examination showed pulmonary congestion, H&E staining showed wall thickening and lumen narrowing in the upstream pulmonary veins, and immunofluorescence showed an increase in the smooth muscle layers in the upstream pulmonary veins. In addition, at P30 in the PVS group, lung remodeling was evidenced by hyperemia, thickening of pulmonary small vessel walls and smooth muscle layers, and reduction of the number of alveoli. RV remodeling was evidenced by an increase in RV free wall thickness. CONCLUSIONS A neonatal rat model of PVS was successfully established, showing secondary lung and RV remodeling. This model may serve as a useful platform for understanding the mechanisms and treatments for PVS.
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Affiliation(s)
- Debao Li
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China
| | - Lisheng Qiu
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China
| | - Haifa Hong
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Chen
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China
| | - Peibin Zhao
- Institute of Cardiovascular Development and Translational Medicine, Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yingying Xiao
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhang
- Institute of Cardiovascular Development and Translational Medicine, Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
| | - Qi Sun
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China.
| | - Lincai Ye
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China.
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
- Institute of Pediatric Translational Medicine, School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.
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3
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Feins EN, Ireland C, Gauvreau K, Chávez M, Callahan R, Jenkins KJ, Baird CW. Pulmonary vein stenosis: Anatomic considerations, surgical management, and outcomes. J Thorac Cardiovasc Surg 2021; 163:2198-2207.e3. [PMID: 34801262 DOI: 10.1016/j.jtcvs.2021.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study objective was to evaluate outcomes of pulmonary vein stenosis repair in a large single-center cohort. METHODS Clinical data from a pulmonary vein stenosis registry were retrospectively reviewed identifying patients who underwent pulmonary vein stenosis repair. The primary/index operation was defined as the patient's first pulmonary vein stenosis operation during the study period. RESULTS Between January 2007 and August 2019, 174 patients underwent pulmonary vein stenosis repair. Bilateral pulmonary vein stenosis occurred in 111 patients (64%); 71 patients (41%) had 4-vessel disease. Fifty-nine patients (34%) had primary pulmonary vein stenosis. Median age was 9 months (interquartile range, 5-27) and weight was 6.5 kg (4.7-10.2). Surgical techniques evolved and included ostial resection, unroofing, reimplantation, sutureless, modified sutureless, and a newer anatomically focused approach of pulmonary vein stenosis resection with lateralization or patch enlargement of the pulmonary vein-left atrium connection. Twenty-three patients (13%) required reoperation. Cumulative 2-year incidence of postoperative transcatheter intervention (balloon dilation ± stenting) was 64%. One-, 2-, and 5-year survivals were 71.2%, 66.8%, and 60.6%, respectively. There was no association between surgery type and reoperation rate (hazard ratio, 2.38, P = .25) or transcatheter intervention (hazard ratio, 0.97, P = .95). The anatomically focused repair was associated with decreased mortality on univariate (hazard ratio, 0.38, P = .042) and multivariable analyses (hazard ratio, 0.19, P = .014). Antiproliferative chemotherapy was also associated with decreased mortality (hazard ratio, 0.47, P = .026). CONCLUSIONS This large single-center surgical pulmonary vein stenosis experience demonstrates encouraging midterm results. A new anatomically focused repair strategy aims to alleviate pulmonary vein angulation to minimize turbulence and shows promising early outcomes. Continued follow-up is required to understand longer-term outcomes for this surgical approach.
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Affiliation(s)
- Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
| | - Christina Ireland
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mariana Chávez
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Feins EN, Callahan R, Baird CW. Pulmonary Vein Stenosis-Evolving Surgical Management of a Challenging Disease. CHILDREN (BASEL, SWITZERLAND) 2021; 8:631. [PMID: 34438522 PMCID: PMC8392559 DOI: 10.3390/children8080631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
Pulmonary vein stenosis (PVS) is an extremely challenging clinical problem in congenital heart disease. It has traditionally required multimodal therapy given its complex underlying pathophysiology. As with other modalities, surgical therapy has undergone tremendous evolution since the 1950s. These evolving strategies have been based upon an improved understanding of the substrates that cause PVS and recurrent vein obstruction. More recent anatomic-based surgical strategies have focused on the pulmonary vein course, and how adjacent mediastinal structures can create a fulcrum effect on the pulmonary veins as they pass from the lung parenchyma to the left atrium. The consequent angulation of pulmonary veins creates altered wall shear stress and likely serves as a nidus for recurrent PVS. Encouraging early results suggest that eliminating pulmonary vein angulation and shortening/straightening the pulmonary vein course may prove effective in surgically managing PVS.
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Affiliation(s)
- Eric N. Feins
- Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Ryan Callahan
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Christopher W. Baird
- Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
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5
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Frank DB, Levy PT, Stiver CA, Boe BA, Baird CW, Callahan RM, Smith CV, Vanderlaan RD, Backes CH. Primary pulmonary vein stenosis during infancy: state of the art review. J Perinatol 2021; 41:1528-1539. [PMID: 33674714 DOI: 10.1038/s41372-021-01008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Primary pulmonary vein stenosis (PPVS) is an emerging problem among infants. In contrast to acquired disease, PPVS is the development of stenosis in the absence of preceding intervention. While optimal care approaches remain poorly characterized, over the past decade, understanding of potential pathophysiological mechanisms and development of novel therapeutic strategies are increasing. A multidisciplinary team of health care providers was assembled to review the available evidence and provide a common framework for the diagnosis, management, and treatment of PPVS during infancy. To address knowledge gaps, institutional and multi-institutional approaches must be employed to generate knowledge specific to ex-premature infants with PPVS. Within individual institutions, creation of a team comprised of dedicated health care providers from diverse backgrounds is critical to accelerate clinical learning and provide care for infants with PPVS. Multi-institutional collaborations, such as the PVS Network, provide the infrastructure and statistical power to advance knowledge for this rare disease.
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Affiliation(s)
- David B Frank
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Corey A Stiver
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christopher W Baird
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ryan M Callahan
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel D Vanderlaan
- Department of Thoracic Surgery, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Carl H Backes
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
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6
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Matsuhisa H, Oshima Y, Higuma T, Matsushima S, Hasegawa S, Wada Y, Matsuoka M, Tanaka T. Computed tomography-based surgical strategy for total anomalous pulmonary venous connection. Eur J Cardiothorac Surg 2021; 58:237-245. [PMID: 32048709 DOI: 10.1093/ejcts/ezaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We used computed tomographic angiography (CTA)-based surgical planning to clarify the anatomical indications of sutureless repair technique for total anomalous pulmonary venous connection. The mid-term impact of the current surgical strategies was evaluated. METHODS One hundred twelve patients underwent repair for total anomalous pulmonary venous connection. The study period was divided into era 1 (1996-2010, n = 56) and era 2 (2011-2018, n = 56). Patients with single ventricular heart (SVH) were included. In era 2, the indications for primary sutureless repair and branch pulmonary vein incision were based on CTA findings. RESULTS For patients with biventricular heart, the 5-year survival was 69% and 97% in eras 1 and 2, respectively (P = 0.0024). For patients with SVH, the 5-year survival was 21% and 70% in eras 1 and 2, respectively (P = 0.0007). During the follow-up period, the evidence of post-repair pulmonary vein stenosis (PVS) was observed in 12 patients with biventricular heart [era 1, 8 patients (23%); era 2, 4 patients (13%)], and 14 patients with SVH [era 1, 6 patients (60%); era 2, 8 patients (36%)]. Using multivariable analysis, preoperative CTA was associated with improved survival in both biventricular heart and SVH and associated with post-repair PVS-free survival in SVH. Since 2011, 12 patients with post-repair PVS underwent multiple reintervention with 1 recorded death (5-year survival: 88%). CONCLUSIONS CTA-based surgical strategy for total anomalous pulmonary venous connection provided significant survival benefit. Although post-repair PVS could occur in era 2, aggressive reintervention appeared to be associated with improved survival and vein patency.
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Affiliation(s)
- Hironori Matsuhisa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Tomonori Higuma
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | | | - Shota Hasegawa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yuson Wada
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Michio Matsuoka
- Department of Cardiology, Kobe Children's Hospital, Kobe, Japan
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Vanderlaan RD, Caldarone CA. Pulmonary Vein Stenosis: Incremental Knowledge Gains to Improve Outcomes. CHILDREN-BASEL 2021; 8:children8060481. [PMID: 34200142 PMCID: PMC8229191 DOI: 10.3390/children8060481] [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: 05/11/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Pulmonary vein stenosis remains a considerable clinical challenge, with high mortality still present in children with progressive disease. In this review, we discuss the clinical spectrum of pulmonary vein stenosis and what is known about the etiology and potential modifying and contributing factors in progressive pulmonary vein stenosis.
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Affiliation(s)
- Rachel D. Vanderlaan
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence: ; Tel.: +1-416-813-1500
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8
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Pulmonary vein stenosis: Treatment and challenges. J Thorac Cardiovasc Surg 2021; 161:2169-2176. [DOI: 10.1016/j.jtcvs.2020.05.117] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022]
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9
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Choi KH, Kim H, Sung SC, Lee HD, Ko H, Byun JH. Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta. J Card Surg 2021; 36:2644-2650. [PMID: 33938583 DOI: 10.1111/jocs.15596] [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: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left pulmonary vein (PV) obstruction can occur due to compression between the left atrium (LA) and the descending aorta (DA). One of the effective solutions for this problem is posterior aortopexy. In this study, we have reported five cases of posterior aortopexy to relieve left PV obstruction between the LA and the DA. METHODS Since August 2012, five patients have undergone posterior aortopexy for compression of the left PV between the LA and the DA. The median age and weight of the patients at the time of operation were 5.5 months (range, 1-131 months) and 5.2 kg (range, 4.2-29.5 kg), respectively. The left PV obstruction was initially diagnosed on echocardiography in four patients and computed tomography angiography in one patient. The median peak pressure gradient across the obstructed left PV was 7.3 mmHg (range, 4-20 mmHg). Concomitant procedures were ventricular septal defect closure in one patient and patent ductus arteriosus ligation in one patient. RESULTS There was no PV obstruction on echocardiography in any of the patients after the operation except in the case of one patient who had diffuse pulmonary vein stenosis. The median follow-up duration was 34 months (range, 14-89 months), and during follow-up no incidence of the left PV obstruction was observed in any of the surviving patients. CONCLUSIONS The posterior aortopexy technique could be a good surgical option for the left PV obstruction caused by compression between the LA and the anteriorly positioned DA.
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Affiliation(s)
- Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Hoon Ko
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
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10
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Evans WN, Acherman RJ, Galindo A, Rothman A, Ciccolo ML, Lehoux J, Winn BJ, Yumiaco NS, Restrepo H. Fontan-associated liver disease and total cavopulmonary anatomical flow effectors. J Card Surg 2021; 36:2329-2335. [PMID: 33834526 DOI: 10.1111/jocs.15553] [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: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We investigated a relationship between a composite index comprised of Fontan-circuit anatomical features and hepatic fibrosis scores from biopsy. METHODS We identified living extracardiac Fontan patients, ≥7 years old and ≥5 but <20 years postoperative, that underwent cardiac catheterization and transvenous liver biopsy between March 2012 and September 2020. We divided patients into anatomical groups and applied a risk score to each patient. We compared average anatomical risk scores with average hepatic total fibrosis scores by group. RESULTS We identified 111 patients that met inclusion criteria. After excluding four patients, we assigned 107 to one of 12 anatomical variant groups (n ≥ 3). For the 107, the average age at liver biopsy was 14 ± 6 years old. Of the 107, 105 (98%) were New York Heart Association Class 1. We found average anatomical risk scores by group correlated with average total fibrosis scores by group (R = 0.8; p = .005). An average Fontan duration to biopsy of 10 ± 1 years was similar for all 12 anatomical groups. We found no other clinical variables, laboratory, or hemodynamic values that trended with anatomical risk scores or hepatic total fibrosis scores. CONCLUSIONS In a cohort of relatively young, stable extracardiac Fontan patients, average composite anatomical risk scores strongly correlated with average hepatic total fibrosis scores by anatomical group. These findings suggest that some anatomical variants in extracardiac Fontan patients are associated with higher Fontan-associated liver disease (FALD)-related hepatic total fibrosis scores than others, despite similar Fontan durations.
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Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Children's Heart Center Nevada, Las Vegas, Nevada, USA
| | - Brody J Winn
- Laboratory Medicine Consultants, Las Vegas, Nevada, USA
| | | | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, School of Medicine, Division of Pediatric Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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11
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Callahan R, Gauthier Z, Toba S, Sanders SP, Porras D, Vargas SO. Correlation of Intravascular Ultrasound with Histology in Pediatric Pulmonary Vein Stenosis. CHILDREN-BASEL 2021; 8:children8030193. [PMID: 33806479 PMCID: PMC7999454 DOI: 10.3390/children8030193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Preliminary intravascular ultrasound (IVUS) images of suspected pediatric intraluminal pulmonary vein stenosis (PVS) demonstrate wall thickening. It is unclear how the IVUS-delineated constituents of wall thickening correlate with the histology. We analyzed six postmortem formalin-fixed heart/lung specimens and four live patients with PVS as well as control pulmonary veins using IVUS and light microscopic examination. In PVS veins, IVUS demonstrated wall thickening with up to two layers of variable echogenicity, often with indistinct borders. Histologically, the veins showed fibroblastic proliferation with areas rich in myxoid matrix as well as areas with abundant collagen and elastic fibers. Discrete vein layers were obscured by scarring and elastic degeneration. A lower reflective periluminal layer by IVUS corresponded with hyperplasia of myofibroblast-like cells in abundant myxoid matrix. The hyper-reflective layer by IVUS extended to the outer edge of the vessel and corresponded to a less myxoid area with more collagen, smooth muscle and elastic fibers. The outer less reflective edge of the IVUS image correlated with a gradual transition into adventitia. Normal veins had a thin wall, correlating with histologically normal cellular and extracellular components, without intimal proliferation. IVUS may provide further understanding of the anatomy and mechanisms of pediatric pulmonary vein obstruction.
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Affiliation(s)
- Ryan Callahan
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (Z.G.); (S.T.); (S.P.S.); (D.P.)
- Correspondence:
| | - Zachary Gauthier
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (Z.G.); (S.T.); (S.P.S.); (D.P.)
| | - Shuhei Toba
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (Z.G.); (S.T.); (S.P.S.); (D.P.)
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Stephen P. Sanders
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (Z.G.); (S.T.); (S.P.S.); (D.P.)
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Diego Porras
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (Z.G.); (S.T.); (S.P.S.); (D.P.)
| | - Sara O. Vargas
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
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12
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Ishidou M, Ota K, Watanebe K, Koshiyama H, Kanno K, Ito H, Murata M, Hirose K, Ikai A, Sakamoto K. Impact of intrapulmonary-artery septation to pulmonary vein obstruction for two-lung Fontan. Eur J Cardiothorac Surg 2020; 58:177-185. [PMID: 32053189 DOI: 10.1093/ejcts/ezaa035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Patients with unbalanced pulmonary artery (PA) growth and decreased unilateral pulmonary circulation are considered unsuitable candidates for the Fontan procedure. Following our previous study on the utility of intrapulmonary-artery septation for patients with PA hypoplasia, we investigated its use in patients with pulmonary venous obstruction (PVO). METHODS We recruited 42 patients who underwent intrapulmonary-artery septation for unilateral PA hypoplasia and/or PVO between 1998 and 2018 and classified them into no PVO or PVO group. We analysed overall survival, success of the Fontan procedure and data from catheterization and echocardiography. In PVO, we evaluated the functional lung area before the Fontan procedure and the relevance of this parameter to operative outcomes. RESULTS The PVO and no-PVO group included 24 and 18 patients, respectively. One patient in the no-PVO and 6 patients in the PVO group died during follow-up; this difference was statistically significant (log-rank P = 0.040). In the no-PVO group, 15 (83%) patients achieved two-lung Fontan circulation. In the PVO group, 12 (50%) patients achieved two-lung Fontan circulation. Multivariate analysis revealed that functional lung area and shunt size [significantly larger in patients with functional lung area ≥50% in affected lung (P = 0.040)] were significant factors for successful two-lung Fontan procedure (P = 0.030). CONCLUSIONS Intrapulmonary-artery septation may contribute to increase functional lung area after PVO release to establish two-lung Fontan circulation in patients with PVO who have unbalanced PA growth and/or decreased unilateral pulmonary circulation.
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Affiliation(s)
- Motonori Ishidou
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keisuke Ota
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kentaro Watanebe
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Koshiyama
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuyoshi Kanno
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Murata
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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Alsaied T, Sleeper LA, Masci M, Ghelani SJ, Azcue N, Geva T, Powell AJ, Rathod RH. Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity. J Cardiovasc Magn Reson 2018; 20:85. [PMID: 30558626 PMCID: PMC6296022 DOI: 10.1186/s12968-018-0505-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/09/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Maldistribution of pulmonary artery blood flow (MPBF) is a potential complication in patients who have undergone single ventricle palliation culminating in the Fontan procedure. Cardiovascular magnetic resonance (CMR) is the best modality that can evaluate MPBF in this population. The purpose of this study is to identify the prevalence and associations of MPBF and to determine the impact of MPBF on exercise capacity after the Fontan operation. METHODS This retrospective single-center study included all patients after Fontan operation who had maximal cardiopulmonary exercise test (CPET) and CMR with flow measurements of the branch pulmonary arteries. MPBF was defined as > 20% difference in branch pulmonary artery flow. Exercise capacity was measured as percent of predicted oxygen consumption at peak exercise (% predicted VO2). Linear and logistic regression models were used to determine univariate and multivariable predictors of exercise capacity and correlates of MPBF, respectively. RESULTS A total of 147 patients who had CMR between 1999 and 2017 were included (median age at CMR 21.8 years [interquartile range (IQR) 16.5-30.6]) and the median time between CMR and CPET was 2.8 months [IQR 0-13.8]. Fifty-three patients (36%) had MPBF (95% CI 29-45%). The mean % predicted VO2 was 63 ± 16%. Patients with MPBF had lower mean % predicted VO2 compared to patients without MPBF (60 ± 14% versus 65 ± 16%, p = 0.04). On multivariable analysis, a lower % predicted VO2 was independently associated with longer time since Fontan, higher ventricular mass-to-volume ratio, and MPBF. On multivariable analysis, only compression of the branch pulmonary arteries by the ascending aorta or aortic root was associated with MPBF (OR 6.5, 95% CI 5.6-7.4, p < 0.001). CONCLUSION In patients after the Fontan operation, MPBF is common and is independently associated with lower exercise capacity. MPBF was most likely to be caused by pulmonary artery compression by the aortic root or the ascending aorta. This study identifies MPBF as an important risk factor and as a potential target for therapeutic interventions in this fragile patient population.
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Affiliation(s)
- Tarek Alsaied
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Marco Masci
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Nina Azcue
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Rahul H. Rathod
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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Vanderlaan RD, Caldarone CA. Sutureless repair and postoperative residual stenosis: "Never leave with a lesion". J Thorac Cardiovasc Surg 2018; 156:287-288. [PMID: 29705540 DOI: 10.1016/j.jtcvs.2018.03.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel D Vanderlaan
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
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Kotani Y, Sano T, Arai S, Kasahara S. Aortopexy for left pulmonary vein obstruction. J Thorac Cardiovasc Surg 2018; 155:e69-e70. [DOI: 10.1016/j.jtcvs.2017.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/18/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
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16
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Decompressing extrinsic pulmonary vein obstruction. J Thorac Cardiovasc Surg 2017; 155:e71-e72. [PMID: 29153435 DOI: 10.1016/j.jtcvs.2017.09.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/20/2022]
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17
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Utility of Cardiac Magnetic Resonance Imaging in the Management of Adult Congenital Heart Disease. J Thorac Imaging 2017. [DOI: 10.1097/rti.0000000000000280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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DeCampli WM. Pulmonary vein stenosis: Plea for a multi-institutional registry. J Thorac Cardiovasc Surg 2016; 151:667-668. [DOI: 10.1016/j.jtcvs.2015.09.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
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19
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Pulmonary vein stenosis: Severity and location predict survival after surgical repair. J Thorac Cardiovasc Surg 2016; 151:657-666.e2. [DOI: 10.1016/j.jtcvs.2015.08.121] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/25/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022]
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20
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Repair Type Influences Mode of Pulmonary Vein Stenosis in Total Anomalous Pulmonary Venous Drainage. Ann Thorac Surg 2015; 100:654-62. [DOI: 10.1016/j.athoracsur.2015.04.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
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21
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Mitchell MB. Pulmonary venous obstruction in the single ventricle patient: Possible causes, possible solutions. J Thorac Cardiovasc Surg 2015; 149:1245-6. [PMID: 25680748 DOI: 10.1016/j.jtcvs.2015.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Max B Mitchell
- Department of Surgery, University of Colorado Health Sciences Center at Denver, and Children's Hospital Colorado Heart Institute, Aurora, Colo.
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