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Ning L, Zanella S, Tomov ML, Amoli MS, Jin L, Hwang B, Saadeh M, Chen H, Neelakantan S, Dasi LP, Avazmohammadi R, Mahmoudi M, Bauser‐Heaton HD, Serpooshan V. Targeted Rapamycin Delivery via Magnetic Nanoparticles to Address Stenosis in a 3D Bioprinted in Vitro Model of Pulmonary Veins. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400476. [PMID: 38696618 PMCID: PMC11234432 DOI: 10.1002/advs.202400476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/09/2024] [Indexed: 05/04/2024]
Abstract
Vascular cell overgrowth and lumen size reduction in pulmonary vein stenosis (PVS) can result in elevated PV pressure, pulmonary hypertension, cardiac failure, and death. Administration of chemotherapies such as rapamycin have shown promise by inhibiting the vascular cell proliferation; yet clinical success is limited due to complications such as restenosis and off-target effects. The lack of in vitro models to recapitulate the complex pathophysiology of PVS has hindered the identification of disease mechanisms and therapies. This study integrated 3D bioprinting, functional nanoparticles, and perfusion bioreactors to develop a novel in vitro model of PVS. Bioprinted bifurcated PV constructs are seeded with endothelial cells (ECs) and perfused, demonstrating the formation of a uniform and viable endothelium. Computational modeling identified the bifurcation point at high risk of EC overgrowth. Application of an external magnetic field enabled targeting of the rapamycin-loaded superparamagnetic iron oxide nanoparticles at the bifurcation site, leading to a significant reduction in EC proliferation with no adverse side effects. These results establish a 3D bioprinted in vitro model to study PV homeostasis and diseases, offering the potential for increased throughput, tunability, and patient specificity, to test new or more effective therapies for PVS and other vascular diseases.
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Affiliation(s)
- Liqun Ning
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
- Department of Mechanical EngineeringCleveland State UniversityClevelandOH44115USA
| | - Stefano Zanella
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Martin L. Tomov
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Mehdi Salar Amoli
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Linqi Jin
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Boeun Hwang
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Maher Saadeh
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Huang Chen
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Sunder Neelakantan
- Department of Biomedical EngineeringTexas A&M UniversityCollege StationTX77843USA
| | - Lakshmi Prasad Dasi
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
| | - Reza Avazmohammadi
- Department of Biomedical EngineeringTexas A&M UniversityCollege StationTX77843USA
- J. Mike Walker ’66 Department of Mechanical EngineeringTexas A&M UniversityCollege StationTX77840USA
| | - Morteza Mahmoudi
- Department of Radiology and Precision Health ProgramMichigan State UniversityEast LandingMI48824USA
| | - Holly D. Bauser‐Heaton
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
- Department of PediatricsEmory University School of MedicineAtlantaGA30322USA
- Children's Healthcare of AtlantaAtlantaGA30322USA
- Sibley Heart Center at Children's Healthcare of AtlantaAtlantaGA30322USA
| | - Vahid Serpooshan
- Wallace H. Coulter Department of Biomedical EngineeringEmory University School of Medicine and Georgia Institute of TechnologyAtlantaGA30322USA
- Department of PediatricsEmory University School of MedicineAtlantaGA30322USA
- Children's Healthcare of AtlantaAtlantaGA30322USA
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2
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Hsien S, Krishnan U, Petit CJ. Interventions for Pulmonary Vein Stenosis. Interv Cardiol Clin 2024; 13:431-438. [PMID: 38839175 DOI: 10.1016/j.iccl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Pulmonary vein stenosis (PVS) is a rare and unique disease of infants and young children. PVS is attended by high morbidity and mortality, and for many decades, effective therapy eluded the practitioner. However, in the most recent era, interventional techniques when employed in combination with systemic (primary) therapy have had a remarkable impact on outcomes in these at-risk children. Despite apparent complete relief of PVS in a discrete region of a pulmonary vein, stenosis reliably recurs and progresses. In this review, we discuss the current state-of-the-art interventional techniques, through the lens of our collective experiences and practices.
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Affiliation(s)
- Sophia Hsien
- Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Usha Krishnan
- Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA.
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3
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Denby KJ, Tereshchenko LG, Kanj M, Taigen T, Callahan T, Dresing T, Tanaka Esposito C, Santangeli P, Hussein A, Hargrave J, Wakefield B, Skubas NJ, Tovar Camargo O, Krishnaswamy A, Nanjundappa A, Puri R, Khatri J, Kapadia S, Suntharos P, Prieto L, Ghobrial J. Efficacy of Drug-Coated Balloon Angioplasty in Pulmonary Vein Stenosis or Total Occlusion. JACC Clin Electrophysiol 2024:S2405-500X(24)00341-4. [PMID: 38904577 DOI: 10.1016/j.jacep.2024.04.020] [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: 01/03/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Current therapies for pulmonary vein stenosis (PVS) or pulmonary vein total occlusion (PVTO) involving angioplasty and stenting are hindered by high rates of restenosis. OBJECTIVES This study compares a novel approach of drug-coated balloon (DCB) angioplasty and stenting with the current standard of care in PVS or PVTO due to pulmonary vein isolation (PVI). METHODS A retrospective single-center study analyzed patients with PVS or PVTO due to PVI who underwent either angioplasty and stenting (NoDCB group; December 2012-December 2016) or DCB angioplasty and stenting (DCB group; January 2018-January 2021). Multivariable Andersen-Gill regression analysis assessed the risk of restenosis and target lesion revascularization (TLR). RESULTS The NoDCB group comprised 58 patients and 89 veins, with a longer median follow-up of 35 months, whereas the DCB group included 26 patients and 33 veins, with a median follow-up of 11 months. The DCB group exhibited more PVTO (NoDCB: 12.3%; DCB: 42.4%; P = 0.0001), with a smaller reference vessel size (NoDCB: 10.2 mm; DCB: 8.4 mm; P = 0.0004). Follow-up computed tomography was performed in 82% of NoDCB and 85% of DCB, revealing lower unadjusted rates of restenosis (NoDCB: 26%; DCB: 14.3%) and TLR (NoDCB: 34.2%; DCB: 10.7%) in the DCB group. DCB use was associated with a significantly lower risk of restenosis and TLR (HR: 0.003: CI: 0.00009-0.118; P = 0.002). CONCLUSIONS The novel approach of DCB angioplasty followed by stenting is effective and safe and significantly reduces the risk of restenosis and reintervention compared with the standard of care in PVS or PVTO due to PVI.
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Affiliation(s)
- Kara J Denby
- Division of Cardiology, Saint Alphonsus Health System, Boise, Idaho, USA
| | - Larisa G Tereshchenko
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Cleveland Clinic Lerner Research Institute, Quantitative Health Sciences, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tyler Taigen
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas Callahan
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas Dresing
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Pasquale Santangeli
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ayman Hussein
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brett Wakefield
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nikolaos J Skubas
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oscar Tovar Camargo
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aravinda Nanjundappa
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jaikirshan Khatri
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Patcharapong Suntharos
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lourdes Prieto
- The Heart Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Joanna Ghobrial
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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4
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Epstein R, Yomogida M, Donovan D, Butensky A, Aidala AA, Farooqi KM, Shah AM, Chelliah A, DiLorenzo MP. Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study. J Cardiovasc Comput Tomogr 2024; 18:267-273. [PMID: 38360501 DOI: 10.1016/j.jcct.2024.02.002] [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: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. METHODS A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. RESULTS Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. CONCLUSION While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.
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Affiliation(s)
- Rebecca Epstein
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
| | - Maiko Yomogida
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Denis Donovan
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Adam Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Angela A Aidala
- Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Amee M Shah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Anjali Chelliah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA; Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
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5
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Kardos M, Curione D, Valverde I, van Schuppen J, Goo HW, Kellenberger CJ, Secinaro A, Caro-Domínguez P. Pediatric Cardiovascular Computed Tomography: Clinical Indications, Technique, and Standardized Reporting. Recommendations From the Cardiothoracic Taskforce of the European Society of Pediatric Radiology. J Thorac Imaging 2024; 39:18-33. [PMID: 37884389 DOI: 10.1097/rti.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Congenital heart diseases affect 1% of all live births in the general population. The prognosis of these children is increasingly improving due to advances in medical care and surgical treatment. Imaging is also evolving rapidly to assess accurately complex cardiac anomalies prenatally and postnatally. Transthoracic echocardiography is the gold-standard imaging technique to diagnose and follow-up children with congenital heart disease. Cardiac computed tomography imaging plays a key role in the diagnosis of children with congenital heart defects that require intervention, due to its high temporal and spatial resolution, with low radiation doses. It is challenging for radiologists, not primarily specialized in this field, to perform and interpret these studies due to the difficult anatomy, physiology, and postsurgical changes. Technical challenges consist of necessary electrocardiogram gating and contrast bolus timing to obtain an optimal examination. This article aims to define indications for pediatric cardiac computed tomography, to explain how to perform and report these studies, and to discuss future applications of this technique.
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Affiliation(s)
- Marek Kardos
- Department of Functional Diagnostics, Children's Cardiac Center, Bratislava, Slovakia
| | - Davide Curione
- Department of Imaging, Advanced Cardiothoracic Imaging Unit, Pediatric Hospital Bambino Gesu, Rome, Italy
| | - Israel Valverde
- Department of Radiology, Pediatric Radiology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital-Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiothoracic Imaging Unit, Pediatric Hospital Bambino Gesu, Rome, Italy
| | - Pablo Caro-Domínguez
- Department of Radiology, Pediatric Radiology Unit, Virgen del Rocio University Hospital, Seville, Spain
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6
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Garg D, Sharma A, Naganur SH, Singhal M. Hitherto Unreported Pattern of Complex Obstructive Partial Anomalous Pulmonary Venous Drainage with Dual Drainage of Accessory Pulmonary Veins. Indian J Radiol Imaging 2024; 34:185-188. [PMID: 38106854 PMCID: PMC10723956 DOI: 10.1055/s-0043-1776107] [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] [Indexed: 12/19/2023] Open
Abstract
Partial anomalous pulmonary venous drainage is a congenital cardiac disorder characterized by abnormal drainage of one or more pulmonary veins into the systemic circulation. It can be isolated or associated with other congenital cardiac anomalies, most commonly atrial septal defect and patent ductus arteriosus. The clinical presentation is variable and depends on the degree of shunting and associated cardiac anomalies. Many patients usually remain asymptomatic until late in life. In this article, we presented a complex case of obstructive partial anomalous pulmonary venous drainage with dual drainage of bilateral accessory pulmonary veins with intact interatrial septum in conjunction with a patent ductus arteriosus and a ventricular septal defect. This pattern is incredibly rare and to the best of our knowledge has not been previously reported. Computed tomography played a pivotal role in precisely elucidating the intricate anatomy in this case with a complex pattern of anomalous pulmonary venous drainage.
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Affiliation(s)
- Dollphy Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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7
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Fujita KT, DiLorenzo MP, Krishnan US, Turner ME, Barry OM, Torres AJ, Bacha EA, Kalfa D, Crystal MA. Outcomes and Risk Factors of Interventions for Pediatric Post-operative Pulmonary Vein Stenosis. Pediatr Cardiol 2023; 44:1778-1787. [PMID: 37422845 DOI: 10.1007/s00246-023-03214-w] [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: 01/31/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023]
Abstract
Pulmonary vein stenosis (PVS) in children is a challenging condition with poor outcomes. Post-operative stenosis can occur after repair of anomalous pulmonary venous return (APVR) or stenosis within native veins. There is limited data on the outcomes of post-operative PVS. Our objective was to review our experience and assess surgical and transcatheter outcomes. Single-center retrospective study was performed including patients < 18 years who developed restenosis after baseline pulmonary vein surgery that required additional intervention(s) from 1/2005 to 1/2020. Non-invasive imaging, catheterization and surgical data were reviewed. We identified 46 patients with post-operative PVS with 11 (23.9%) patient deaths. Median age at index procedure was 7.2 months (range 1 month-10 years), and median follow-up was 10.8 months (range 1 day-13 years). Index procedure was surgical in 36 (78.3%) and transcatheter in 10 (21.7%). Twenty-three (50%) patients developed vein atresia. Mortality was not associated with number of affected veins, vein atresia, or procedure type. Single ventricle physiology, complex congenital heart disease (CCHD), and genetic disorders were associated with mortality. Survival rate was higher in APVR patients (p = 0.03). Patients with three or more interventions had a higher survival rate compared to patients with 1-2 interventions (p = 0.02). Male gender, necrotizing enterocolitis, and diffuse hypoplasia were associated with vein atresia. In post-operative PVS, mortality is associated with CCHD, single ventricle physiology, and genetic disorders. Vein atresia is associated with male gender, necrotizing enterocolitis, and diffuse hypoplasia. Multiple repeated interventions may offer a patient survival benefit; however, larger prospective studies are necessary to elucidate this relationship further.
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Affiliation(s)
- Kristin T Fujita
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA.
| | - Michael P DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Usha S Krishnan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Oliver M Barry
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Alejandro J Torres
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Emile A Bacha
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - David Kalfa
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
| | - Matthew A Crystal
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, USA
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8
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Ghobrial J. Drug-Coated Balloon Angioplasty in Pulmonary Vein Stenosis: A Promising Tool. JACC Case Rep 2023; 24:102021. [PMID: 37869220 PMCID: PMC10589446 DOI: 10.1016/j.jaccas.2023.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Joanna Ghobrial
- Address for correspondence: Dr Joanna Ghobrial, Cleveland Clinic, Department of Cardiovascular Medicine, 9500 Euclid Avenue, Cleveland, Ohio 99175, USA.
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9
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Bala V P, Barathi S D, Govindarajalou R, M S. Multidetector Computed Tomography (MDCT) Angiography Evaluation of Total Anomalous Pulmonary Venous Connection. Cureus 2023; 15:e46852. [PMID: 37954719 PMCID: PMC10637365 DOI: 10.7759/cureus.46852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular malformation in which all four pulmonary veins anomalously drain into the right atrium (RA) either directly or indirectly. There are four main types based on the site of connection. Any type of TAPVC may be associated with obstruction and presents early in the neonatal period with cyanosis, tachycardia, or respiratory distress. We present four cases of all types of TAPVC and its imaging findings in multidetector computed tomography (MDCT) angiography. Cardiac CT and magnetic resonance imaging (MRI) are very useful in delineating the anatomy and drainage pathway of anomalous pulmonary veins. MDCT angiography is noninvasive and easily available, and rapid image acquisition is possible with high spatial resolution. Since early diagnosis and surgical correction are necessary for the survival of these neonates, rapid image acquisition using MDCT angiography can be preferred over MRI.
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Affiliation(s)
- Priyadharshini Bala V
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Deepak Barathi S
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ramkumar Govindarajalou
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Selvaganesan M
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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10
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Simard T, Sarma D, Miranda WR, Jain CC, Anderson JH, Collins JD, El Sabbagh A, Jhand A, Peikert T, Reeder GS, Munger TM, Packer DL, Holmes DR. Pathogenesis, Evaluation, and Management of Pulmonary Vein Stenosis: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:2361-2373. [PMID: 37316116 DOI: 10.1016/j.jacc.2023.04.016] [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: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/16/2023]
Abstract
Pulmonary vein stenosis (PVS) can arise from several etiologies, including congenital, acquired, and iatrogenic sources. PVS presents insidiously, leading to significant delays in diagnosis. A high index of suspicion and dedicated noninvasive evaluation are key to diagnosis. Once diagnosed, both noninvasive and invasive evaluation may afford further insights into the relative contribution of PVS to symptoms. Treatment of underlying reversible pathologies coupled with transcatheter balloon angioplasty and stenting for persistent severe stenoses are established approaches. Ongoing refinements in diagnostic modalities, interventional approaches, postintervention monitoring, and medical therapies hold promise to further improve patient outcomes.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/tjsimard
| | - Dhruv Sarma
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/SarmaDhruv
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas L Packer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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11
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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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12
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Weldetsadik AY, Kebede A, Godu BG, Gama M. Unilateral pulmonary vein atresia presenting with recurrent hemoptysis and bronchial varices in an Ethiopian adolescent: a case report. J Med Case Rep 2023; 17:246. [PMID: 37269023 DOI: 10.1186/s13256-023-03956-4] [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: 12/14/2021] [Accepted: 04/27/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Congenital unilateral pulmonary vein atresia is a rare anomaly resulting from failure of the pulmonary vein to incorporate in the left atrium. It is a very rare cause of recurrent respiratory infections and hemoptysis requiring a high index of suspicion for proper diagnosis and management in early childhood. CASE PRESENTATION We report a 13-year old Anuac (Ethiopia, Region of Gambela) male adolescent with a delayed diagnosis of isolated atresia of the left pulmonary veins despite early childhood presentation with recurrent chest infections, hemoptysis and exercise intolerance. Contrast enhanced CT of thorax with reconstructed planes confirmed the diagnosis. He underwent pneumonectomy for severe and recurrent symptoms and did well on subsequent follow ups after 6 months of pneumonectomy. CONCLUSION Although a rare anomaly, congenital unilateral pulmonary vein atresia should be considered in the differential diagnosis of a child presenting with recurrent chest infections, exercise intolerance and hemoptysis to facilitate early appropriate diagnosis and treatment.
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Affiliation(s)
| | - Abdi Kebede
- Department of Pediatrics and Child Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Binyam Gebremedhin Godu
- Pediatric Surgery Unit, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maru Gama
- Department of Surgery, Pediatric Surgery Unit, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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13
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Menahem S, Sehgal A, Wurzel DF. Persistent Tachypnoea in Early Infancy: A Clinical Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050789. [PMID: 37238337 DOI: 10.3390/children10050789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/27/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Tachypnoea in the newborn is common. It may arise from the many causes of the respiratory distress syndrome such as hyaline membrane disease, transient tachypnoea of the newborn, meconium aspiration etc. Congenital heart disease rarely presents with early tachypnoea on day one or two, in contrast to the early presentation of cyanosis, unless there is "pump" (ventricular) failure such as may occur in a cardiomyopathy/myocarditis, or as a result of severe obstruction to either ventricle. Space-occupying lesions within the chest, for example from a diaphragmatic hernia or a congenital cystic adenomatoid malformation, may present with early tachypnoea, as can a metabolic cause resulting in acidosis. The aim of this paper, however, is to focus on infants where the tachypnoea persists or develops beyond the newborn period, at times with minimal signs but occasionally with serious underlying pathology. They include causes that may have originated in the newborn but then persist; for example, arising from pulmonary hypoplasia or polycythemia. Many congenital cardiac abnormalities, particularly those causing left sided obstructive lesions, or those due to an increasing left to right shunt from large communications between the systemic and pulmonary circulations, need be considered. Respiratory causes, for example arising from aspiration, primary ciliary dyskinesia, cystic fibrosis, or interstitial lung disease, may lead to ongoing tachypnoea. Infective causes such as bronchiolitis or infantile wheeze generally are readily recognisable. Finally, there are a few infants who present with persistent tachypnoea over the first few weeks/months of their life who remain well and have normal investigations with the tachypnoea gradually resolving. How should one approach infants with persistent tachypnoea?
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Affiliation(s)
- Samuel Menahem
- Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
- Australian Centre for Heart Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne Children's Cardiology/Adult Congenital Heart, 53 Kooyong Road Caulfield North, Melbourne, VIC 3161, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
- Monash Newborn, Monash Health, Clayton, VIC 3168, Australia
- Neonatal Cardiovascular Research, Monash Health, Clayton, VIC 3168, Australia
| | - Danielle F Wurzel
- Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Parkville, VIC 3052, Australia
- Allergy and Lung Health Unit, University of Melbourne, Parkville, VIC 3052, Australia
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14
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Cho KH, Hayashi S, Jin ZW, Kim JH, Murakami G, Rodríguez-Vázquez JF. The so-called absorption process of the pulmonary vein into the left atrium of the heart: a histological study using human embryos and fetuses. Surg Radiol Anat 2023; 45:469-478. [PMID: 36786933 DOI: 10.1007/s00276-023-03100-3] [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: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Embryonic pulmonary veins (PVs) are believed to be absorbed into the left atrium (LA) to provide an adult morphology in which "four" veins drain separately into the atrium. MATERIALS AND METHODS Serial histological sections were obtained from 27 human embryos and fetuses. RESULTS Between 5 and 6 weeks, the four PVs joined together to form a trunk-like structure (initial spatium pulmonalis) that was larger than the initial LA (two-ostia pattern). The cardiac nerves ran inferiorly along the posterior aspect of the four veins, as well as the spatium. At and until 7 weeks, the cardiac nerves were concentrated to elongate the nerve fold, and the latter separated the left PV trunk from the expanding LA (left spatium). Similarly, the right PV opened to a thick and deep LA recess (right spatium). At 8-12 weeks, depending on the growth of the LA, the opening of the left and right PVs became distant, and the spatium was elongated transversely. The left spatium was enlarged to open widely to the proper left atrium in contrast to the right spatium pushed anteriorly by the right atrium. The three-ostia pattern was transiently observed because of the lost delimitation between the left spatium and proper atrium. The myocardium was thin in the left spatium behind the left atrial nerve fold, whereas the right spatium was tube-like with a thick myocardium. CONCLUSIONS The four-ostia pattern seemed to be established at birth due to a drastically increased venous return from the lung, resulting in a flat smooth left atrial posterior wall.
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Affiliation(s)
- Kwang Ho Cho
- Department of Neurology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine and Hospital, 895, Muwang-Ro, Iksan-Si, Jeollabuk-do, 54538, Republic of Korea.
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Zhe Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
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15
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Cardiovascular magnetic resonance pulmonary perfusion for functional assessment of pulmonary vein stenosis. Int J Cardiol 2023; 376:147-153. [PMID: 36791965 DOI: 10.1016/j.ijcard.2023.02.011] [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: 10/25/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging allows to combine pulmonary perfusion measurements and pulmonary venous angiography during a single-session examination with both imaging modules representing the basis for accurate diagnosis and therapeutic stratification of pulmonary vein (PV) stenosis. The present study investigated the clinical utility of dynamic pulmonary perfusion imaging integrated into a comprehensive CMR protocol for the evaluation of patients with suspected PV stenosis. METHODS 162 patients with clinically suspected PV stenosis after catheter ablation of atrial fibrillation underwent a combined single-session CMR examination (cardiac cine imaging, dynamic pulmonary perfusion, and three-dimensional PV angiography). CMR angiography was used for visual grading of PV stenoses; dynamic pulmonary perfusion imaging was evaluated per lung lobe visually and quantitatively. RESULTS All PV stenosis ≥90% showed a visible perfusion deficit of the corresponding lung lobe (60/60, 100%) while all PVs with luminal narrowing <50% exhibited normal pulmonary perfusion (680/680, 100%). However, every third 70-89% stenosis showed a normal pulmonary perfusion (10/31, 32%) while every fourth 50-69% PV stenosis was associated with hypoperfusion of the corresponding lung lobe (9/39, 23%). For quantitative pulmonary perfusion measurements, ROC analysis demonstrated high discriminatory power regarding PV stenosis detection with the highest AUC values for time-to-peak enhancement (cut-off value, 8.5 s). CONCLUSIONS The combination of CMR angiography and CMR pulmonary perfusion allowed for assessment of the anatomical degree of PV stenosis and its hemodynamic impact on the pulmonary parenchymal level. Thus, the proposed comprehensive CMR protocol provided an efficient diagnostic work-up of patients with suspected PV stenosis.
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16
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Upadhya P, Garg S, A J, Ponraj ND, Wayez A. An unexpected and unusual cause of pulmonary hypertension in a patient with hypersensitivity pneumonitis: a partial anomalous pulmonary venous connection causing pulmonary artery hypertension. Monaldi Arch Chest Dis 2023; 94. [PMID: 36867063 DOI: 10.4081/monaldi.2023.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Partial anomalous pulmonary venous connection (PAPVC) occurs when any pulmonary vein, but not all, drains directly into the right atrium or its venous tributaries. PAPVC can very rarely present as an individual cause of pulmonary artery hypertension. Here we are presenting the case of a 41-year-old farmer with a history of exertional dyspnea for the past 3 years, which increased over 6 months. Chest high-resolution computed tomography was suggestive of non-fibrotic hypersensitivity pneumonitis. Hence, the patient was started on systemic steroids, with which the patient's oxygen saturation improved. On 2D echocardiography, the right ventricle systolic pressure was 48 + right atrial pressure. Right heart catheterization showed a mean pulmonary artery pressure of 73 mmHg and pulmonary vascular resistance of 8.7. On further evaluation, a computed tomography pulmonary angiogram was done, which surprisingly revealed the left superior pulmonary vein draining into the left brachiocephalic vein.
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Affiliation(s)
- Pratap Upadhya
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.
| | - Shivam Garg
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.
| | - Jeevanandham A
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.
| | - Nesamani Daniel Ponraj
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.
| | - Ahmed Wayez
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.
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17
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Combination Chemotherapy in Severe Pulmonary Vein Stenosis-A Case Series. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020364. [PMID: 36832493 PMCID: PMC9954861 DOI: 10.3390/children10020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
Pulmonary vein stenosis results from a proliferative process that leads to the progressive obstruction of venous return to the left atrium. It is often resistant to catheterization and surgical based interventions and is frequently fatal when encountered in its severe form. Here, we describe three patients with severe, primary pulmonary vein stenosis that was progressing despite aggressive conventional management strategies. All three patients were initiated on combination chemotherapy with imatinib and sirolimus, drugs which have been previously shown to independently have potential benefit against PVS. Soon after the initiation of these therapies, all three patients experienced a stabilization of their disease process and clinical improvement. All three patients remain alive, with tolerable side effects from the medications. Although early in our experience and with only a small number of patients, combination chemotherapy with imatinib and sirolimus shows promise and merits further investigation as a therapeutic option for this aggressive disease.
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18
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Frogel J, Navon S, Astbury JC, Augoustides JG, Coleman SR, Fernando RJ, Krishnan S, Desai RG, Patel KM. Echocardiographic Diagnosis and Management of Unexpected Pulmonary Vein Stenosis After Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2023; 37:149-157. [PMID: 36372719 DOI: 10.1053/j.jvca.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center, Ramat Gan, Israel
| | - Shanee Navon
- Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey C Astbury
- Department of Anesthesiology, Butler Health System, Lake Erie School of Osteopathic Medicine, Butler, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott R Coleman
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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19
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Bou-Chaaya RG, Zhu Z, Duarte VE, Lin CH. Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review. Methodist Debakey Cardiovasc J 2023; 19:78-90. [PMID: 37213883 PMCID: PMC10198245 DOI: 10.14797/mdcvj.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Structural interventions play a crucial role in the management of adult congenital heart disease (ACHD). In recent years, this field has seen significant advancements in catheter-based procedures despite limited investment from industry and lack of device development specific to this population. Because each patient is unique in their anatomy, pathophysiology, and surgical repair, many devices are used off-label with a "best fit" strategy. Therefore, continuous innovation is needed to adapt what is available to ACHD and to increase collaboration with industry and regulatory bodies to develop dedicated equipment. These innovations will further advance the field and offer this growing population less invasive options with fewer complications and faster recovery times. In this article, we summarize some of the contemporary structural interventions performed in adults with congenital defects and present cases performed at Houston Methodist to better illustrate them. We aim to offer a greater understanding of the field and stimulate interest in this rapidly growing specialty.
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Affiliation(s)
- Rody G. Bou-Chaaya
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Zhihao Zhu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Valeria E. Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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20
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A Case of Congenital Pulmonary Vein Stenosis with Secondary Post-Capillary Pulmonary Hypertension and Left Sided Congestive Heart Failure in a Cat. Vet Sci 2022; 10:vetsci10010023. [PMID: 36669024 PMCID: PMC9864943 DOI: 10.3390/vetsci10010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
A five-month-old, 3.8 kg intact male Maine coon cat presented for dyspnea characterized by increased respiratory effort in addition to open-mouth breathing. Thoracic radiographs showed pectus excavatum, enlarged cardiac silhouette, and generalized interstitial patterns. Echocardiography revealed normal left atrial (LA) and left ventricular dimensions. A large tubular structure, suspected to be a distended pulmonary vein (PV), was identified as draining into the LA. Severe eccentric and concentric right ventricular hypertrophy and paradoxical septal motion were noted. Based on Doppler echocardiography, both pulmonary venous and pulmonary artery pressure was severely elevated. Clinical, radiographic, and echocardiographic abnormalities were hypothesized to result from pulmonary vein stenosis (PVS), causing severely elevated pulmonary venous pressures and resulting in clinical signs of left-sided congestive heart failure (L-CHF) and severe post-capillary pulmonary hypertension (Pc-PH). The prognosis for good quality of life was assessed as poor, and the owner elected euthanasia. Necropsy confirmed the presence of PVS with severe dilation of the PVs draining all but the left cranial lung lobe. All lung lobes except the left cranial lobe had increased tissue density and a mottled cut surface. This case report shows that, in rare cases, both L-CHF and Pc-PH may be present without LA enlargement. To the authors' knowledge, this is the first report on PVS in veterinary medicine.
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21
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Akintoye E, Renapurkar R, Hughes D, Kapadia S, Harb SC. Dynamic Pulmonary Vein Stenosis-Utility of Multimodality Imaging and Invasive Assessment. Circ Cardiovasc Imaging 2022; 15:e014318. [PMID: 36172857 DOI: 10.1161/circimaging.122.014318] [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] [Indexed: 01/31/2023]
Affiliation(s)
| | - Rahul Renapurkar
- Department of Radiology (R.R.), Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Samir Kapadia
- Section of Invasive and Interventional Cardiology (S.K.), Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Serge C Harb
- Section of Cardiovascular Imaging (E.A., D.H., S.C.H.)
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22
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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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23
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Johnson B, Dobkin SL, Josephson M. Extracorporeal membrane oxygenation as a bridge to transplant in neonates with fatal pulmonary conditions: A review. Paediatr Respir Rev 2022; 44:31-39. [PMID: 36464576 DOI: 10.1016/j.prrv.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
Neonates with progressive respiratory failure should be referred early for subspecialty evaluation and lung transplantation consideration. ECMO should be considered for patients with severe cardiopulmonary dysfunction and a high likelihood of death while on maximal medical therapy, either in the setting of reversible medical conditions or while awaiting lung transplantation. While ECMO offers hope to neonates that experience clinical deterioration while awaiting transplant, the risks and benefits of this intervention should be considered on an individual basis. Owing to the small number of infant lung transplants performed yearly, large studies examining the outcomes of various bridging techniques in this age group do not exist. Multiple single-centre experiences of transplanted neonates have been described and currently serve as guidance for transplant teams. Future investigation of outcomes specific to neonatal transplant recipients bridged with advanced devices is needed.
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Affiliation(s)
- Brandy Johnson
- Division of Pediatric Pulmonary Medicine, UF Health Shands Children's Hospital, Gainesville, FL, USA; Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Shoshana Leftin Dobkin
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Maureen Josephson
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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24
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Touray M, Ladouceur M, Bouchardy J, Schwerzmann M, Greutmann M, Tobler D, Engel R, Gabriel H, Pruvot E, Blanche C, Sekarski N, Rutz T. Arrhythmic Burden of Adult Survivors With Repaired Total Anomalous Pulmonary Venous Connection. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:263-269. [PMID: 37969488 PMCID: PMC10642084 DOI: 10.1016/j.cjcpc.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2023]
Abstract
Background The long-term outcome of adults with repaired total anomalous pulmonary venous connection (TAPVC) is poorly documented. Therefore, the present study aims to provide current clinical data on adult survivors with repaired TAPVC focusing on arrhythmia. Methods Clinical and imaging data (prevalence and type of arrhythmias, symptoms, surgical and medical treatment, echocardiographic and cardiac magnetic resonance haemodynamic parameters) were retrospectively collected from 8 European centres and compared between patients with and without arrhythmias. Results Fifty-seven patients were included (age 20 [16-67] years [female 28, 49%]). At the last follow-up, that is, 21 (8-51) years after surgery, 79% and 93% of patients were free of symptoms and cardiac medication, respectively. The prevalence of late arrhythmias was 21%; 9 (16%) patients showed intra-atrial re-entrant tachycardia (IART) and 2 (4%) ventricular arrhythmias. Patients with IART were older (P = 0.018) and 4 (7%) required antiarrhythmic medication. Three patients (5%) underwent an electrophysiological study, and another 3 (5%) underwent pacemaker implantation within 36 months after surgical correction, which were removed in 2 patients after 7 years. Early postoperative arrhythmias (P = 0.005), right ventricular dilatation (P = 0.003), and valvulopathy (P = 0.009) were more often present in patients with late IART. Conclusions Adult survivors after isolated-TAPVC repair presented a high prevalence of arrhythmias. Age, right ventricular dilatation, early arrhythmias, and valvular lesions are risk factors for IART. Long-term follow-up is important as some of these currently asymptomatic patients will probably develop arrhythmias in the future.
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Affiliation(s)
- Mariama Touray
- Service of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Judith Bouchardy
- Service of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Center for Congenital Heart Disease, Inselspital, University of Bern, Bern, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Reto Engel
- Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Etienne Pruvot
- Service of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Coralie Blanche
- Cardiology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121810. [PMID: 36553257 PMCID: PMC9777095 DOI: 10.3390/children9121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.
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26
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Akiki L, Siblani D, Abi Saleh W, Chamoun C, Abouzahr L, Shatila W. Pulmonary vein stenosis presenting as massive hemoptysis, treated with pulmonary veins angioplasty. Clin Case Rep 2022; 10:e6584. [DOI: 10.1002/ccr3.6584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/25/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laura Akiki
- Department of Internal Medicine Clemenceau Medical Center Beirut Lebanon
| | - Dima Siblani
- Department of Pulmonary and Critical Care Medicine Clemenceau Medical Center Beirut Lebanon
| | - Wajdy Abi Saleh
- Department of Pulmonary and Critical Care Medicine Clemenceau Medical Center Beirut Lebanon
| | - Clara Chamoun
- Department of Pulmonary and Critical Care Medicine Clemenceau Medical Center Beirut Lebanon
| | - Labib Abouzahr
- Department of Cardiothoracic Surgery Clemenceau Medical Center Beirut Lebanon
| | - Wassim Shatila
- Department of Interventional Cardiology Clemenceau Medical Center Beirut Lebanon
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27
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Zablah JE, O'Callaghan B, Shorofsky M, Ivy D, Morgan GJ. Technical Feasibility on the Use of Optical Coherence Tomography in the Evaluation of Pediatric Pulmonary Venous Stenosis. Pediatr Cardiol 2022; 43:1054-1063. [PMID: 35037988 DOI: 10.1007/s00246-022-02824-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Pulmonary vein stenosis (PVS) in children is a morbid disease and limited progress has been made in improving outcomes for this heterogenous group of patients. Evaluation is currently limited to imaging techniques that fail to provide an adequate overview of the intraluminal and luminal pathology perpetuating our limited understanding of this condition. Optical coherence tomography (OCT) is an imaging modality which provides intraluminal profiling with microstructural detail through optical reflective technology. We sought to evaluate whether its use was technically feasible in pediatric PVS and whether the imaging data provided potentially useful outputs for clinical utility. Eleven patients were prospectively selected from our cardiac catheterization for OCT evaluation of their pulmonary veins (PV) during elective catheterization for PVS. Measurements were taken both pre and post intervention using both manual and automated tools. Stent morphology was characterized. Eleven patients had evaluation of 34 pulmonary veins, with 7 patients having more than one assessment, for a total of 25 overall catheterizations. Most patients were female (75%). Median age at cardiac catheterization was 35 months (range 5-45 months). Median weight of subjects was 10.6 kg (3.7-14.2) with a median BSA documented at 0.505 m2 (0.21-0.57). Median number of pulmonary veins involved was 3, (range 1-5 veins) and median contrast volume of 2.9 mL/kg (0.7-3.7) given. Median radiation dose (DAP) was 6095 µGy·cm2 (1670-12,400). Median number of previous cardiac catheterizations was 7 (range 1-11). All of the vessels with a diameter < 5 mm were adequately visualized. Of all the OCT images acquired, in 15 vessels (44%) contrast was used to clear the vessels from blood as an angiogram was required at the time, in the other 19 vessels (56%), saline was used with adequate imaging. There were no complications related to OCT. OCT is technically feasible to use in pediatric patients without any directly related complications. It provides intraluminal anatomy in children with both native and treated pulmonary venous stenosis when vessel size is less than 5 mm.
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Affiliation(s)
- Jenny E Zablah
- The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Barry O'Callaghan
- The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Shorofsky
- The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dunbar Ivy
- The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gareth J Morgan
- The Heart Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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28
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Wan Z, Li X, Sun J, Li X, Liu Z, Dong H, Zhou Q, Qiu H, Xu J, Yang T, Wang WJ, Ou Y. Peripheral Blood Transcripts Predict Preoperative Obstructive Total Anomalous Pulmonary Venous Connection. Front Cardiovasc Med 2022; 9:892000. [PMID: 35711367 PMCID: PMC9194086 DOI: 10.3389/fcvm.2022.892000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
The lack of accessible noninvasive tools to examine the molecular alterations limits our understanding of the causes of total anomalous pulmonary venous connection (TAPVC), as well as the identification of effective operational strategies. Here, we consecutively enrolled peripheral leukocyte transcripts of 26 preoperative obstructive and 22 non-obstructive patients with TAPVC. Two-hundred and fifty six differentially expressed mRNA and 27 differentially expressed long noncoding RNA transcripts were dysregulated. The up-regulated mRNA was enriched in the hydrogen peroxide catabolic process, response to mechanical stimulus, neutrophil degranulation, hemostasis, response to bacterium, and the NABA CORE MATRISOME pathway, all of which are associated with the development of fibrosis. Furthermore, we constructed predictive models using multiple machine-learning algorithms and tested the performance in the validation set. The mRNA NR3C2 and lncRNA MEG3 were screened based on multiple iterations. The random forest prediction model can predict preoperative obstruction patients in the validation set with high accuracy (area under curve = 1; sensitivity = 1). These data highlight the potential of peripheral leukocyte transcripts to evaluate obstructive-related pathophysiological alterations, leading to precision healthcare solutions that could improve patient survival after surgery. It also provides a novel direction for the study of preoperative obstructive TAPVC.
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Affiliation(s)
- Zunmin Wan
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaohong Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinghua Sun
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- BGI-Shenzhen, Shenzhen, China
| | - Xiaohua Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Haojian Dong
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Hailong Qiu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Tingyu Yang
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- BGI-Shenzhen, Shenzhen, China
| | | | - Yanqiu Ou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Yanqiu Ou
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29
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Prematurity and Pulmonary Vein Stenosis: The Role of Parenchymal Lung Disease and Pulmonary Vascular Disease. CHILDREN 2022; 9:children9050713. [PMID: 35626890 PMCID: PMC9139735 DOI: 10.3390/children9050713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
Pulmonary vein stenosis (PVS) has emerged as a critical problem in premature infants with persistent respiratory diseases, particularly bronchopulmonary dysplasia (BPD). As a parenchymal lung disease, BPD also influences vascular development with associated pulmonary hypertension recognized as an important comorbidity of both BPD and PVS. PVS is commonly detected later in infancy, suggesting additional postnatal factors that contribute to disease development, progression, and severity. The same processes that result in BPD, some of which are inflammatory-mediated, may also contribute to the postnatal development of PVS. Although both PVS and BPD are recognized as diseases of inflammation, the link between them is less well-described. In this review, we explore the relationship between parenchymal lung diseases, BPD, and PVS, with a specific focus on the epidemiology, clinical presentation, risk factors, and plausible biological mechanisms in premature infants. We offer an algorithm for early detection and prevention and provide suggestions for research priorities.
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30
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Patel T, Kelleman M, Pickard S, Miller J, Suthar D, Sachdeva R. Implementation of Appropriate Use Criteria for Transthoracic Echocardiography in Follow up Care of Pediatric Patients with Congenital Heart Disease. J Am Soc Echocardiogr 2022; 35:1084-1090.e19. [PMID: 35568251 DOI: 10.1016/j.echo.2022.04.016] [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: 01/06/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Indications for transthoracic echocardiography (TTE) from the 2020 Appropriate Use Criteria (AUC) for congenital heart disease (CHD) were incorporated into our electronic ordering system as a clinical decision support tool. The purpose of this study was to evaluate TTE utilization and factors affecting appropriateness of TTE orders during follow-up care of patients with CHD. METHODS All TTEs performed during follow-up clinic visits from 5/1/2020 to 11/30/2020 were included. TTE indications were rated appropriate (A), may be appropriate (M), or rarely appropriate (R) based on the AUC, and unclassifiable if indication was not in the document but related to included lesions. CHD was graded as simple, moderate, and complex based on Bethesda classification. Logistic regression was used to determine association of ratings with patient age, insurance status, CHD complexity, clinician experience and specialty. RESULTS Of the 5158 studies, 3979 (77.2%) were for CHD included in the AUC document, 322 (8%) were unclassifiable, 37 (0.7%) for CHD not in the document, and 1142 (22.1%) for non-CHD indications. Of the 3657 TTEs to which AUC ratings could be applied, 95.6% were A, 2.4% M, and 2.0% R. The highest utilization of TTE was for follow-up of ventricular septal defects, left ventricular outflow tract obstruction, and single ventricles; 46% for unrepaired CHD; 78% for routine surveillance and the remaining for a change in clinical status. On multivariable analysis, the only significant factor associated with M/R ratings was simple CHD [OR 11.58 (95% CI 5.36 - 24.98), p<0.001]. CONCLUSIONS Three-quarters of the TTEs ordered during follow-up care in pediatric cardiology clinics are for indications related to CHD. Most TTEs for follow-up of CHD were for routine surveillance and indications rated A. TTE orders for M/R ratings were associated with simple CHD. Though the 2020 AUC document successfully stratifies majority of indications related to CHD, future documents should consider the unclassifiable CHD indications and the non-CHD indications.
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Affiliation(s)
- Trisha Patel
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
| | | | - Sarah Pickard
- Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jamison Miller
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Divya Suthar
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Ritu Sachdeva
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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31
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Yung D, Freeman K, Mirzaa G. Pulmonary Vein Stenosis Associated with Germline PIK3CA Mutation. CHILDREN 2022; 9:children9050671. [PMID: 35626846 PMCID: PMC9139298 DOI: 10.3390/children9050671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
Pulmonary vein stenosis is a rare and frequently lethal childhood disease. There are few known genetic associations, and the pathophysiology is not well known. Current treatments include surgery, interventional cardiac catheterization, and more recently, medications targeting cell proliferation, which are not uniformly effective. We present a patient with PVS and a PIK3CA mutation, who demonstrated a good response to the targeted inhibitor, alpelisib.
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Affiliation(s)
- Delphine Yung
- Department of Pediatrics, Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98105, USA;
- Correspondence:
| | - Kaitlyn Freeman
- Department of Pediatrics, Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Ghayda Mirzaa
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98105, USA;
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA
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32
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Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [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] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
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Kindzelski BA, Ghobrial J, Schlenk R, Pettersson GB, Raymond DP. Multidisciplinary Approach to Isolated Pulmonary Vein Compression by an Enlarging Vertebral Osteophyte. JACC Case Rep 2022; 4:145-149. [PMID: 35199005 PMCID: PMC8853948 DOI: 10.1016/j.jaccas.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
Compression of mediastinal structures by vertebral osteophytes is rare. We report a case of pulmonary vein compression by a vertebral osteophyte that failed stenting. A minimally invasive approach to osteophyte removal with subsequent re-expansion angioplasty yielded an optimal outcome, negating the need for cardiopulmonary bypass, stent removal, and pulmonary venoplasty. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Bogdan A. Kindzelski
- Heart, Vascular, and Thoracic Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joanna Ghobrial
- Heart, Vascular, and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Schlenk
- Neurological institute, Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gösta B. Pettersson
- Heart, Vascular, and Thoracic Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel P. Raymond
- Heart, Vascular, and Thoracic Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Address for correspondence: Dr Daniel P. Raymond, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk J4-1, Cleveland, Ohio 44195, USA.
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34
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Maisat W, Yuki K. Predictive factors for postoperative ICU admission and mechanical ventilation following cardiac catheterization for pediatric pulmonary vein stenosis. J Cardiothorac Vasc Anesth 2022; 36:2500-2508. [DOI: 10.1053/j.jvca.2022.02.024] [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] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 11/11/2022]
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35
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Lee HN, Hyun D. Pulmonary Arteriovenous Malformation and Its Vascular Mimickers. Korean J Radiol 2022; 23:202-217. [PMID: 35029077 PMCID: PMC8814702 DOI: 10.3348/kjr.2021.0417] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Pulmonary arteriovenous malformation (AVM) is a congenital vascular disease in which interventional radiologists can play both diagnostic and therapeutic roles in patient management. The diagnosis of pulmonary AVM is simple and can usually be made based on CT images. Endovascular treatment, that is, selective embolization of the pulmonary artery feeding the nidus of the pulmonary AVM, and/or selectively either the nidus or draining vein, has become a first-line treatment with advances in interventional devices. However, some vascular diseases can simulate pulmonary AVMs on CT and pulmonary angiography. This subset can confuse interventional radiologists and referring physicians. Vascular mimickers of pulmonary AVM have not been widely known and described in detail in the literature, although some of these require surgical correction, while others require regular follow-up. This article reviews the clinical and radiologic features of pulmonary AVMs and their mimickers.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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36
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Lin Y, Amin EK, Keller RL, Teitel DF, Nawaytou HM. Doppler Echocardiography Features of Pulmonary Vein Stenosis in Ex-Preterm Children. J Am Soc Echocardiogr 2022; 35:435-442. [PMID: 34986343 DOI: 10.1016/j.echo.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiography is used to screen for the presence of pulmonary vein stenosis (PVS) in ex-preterm infants and children. However, there are no standard accepted criteria for the screening or diagnosis of PVS by echocardiography. In this study, we aim to identify Doppler waveform features and Doppler systolic and diastolic velocity cutoff values associated with a diagnosis of PVS by cardiac catheterization. METHODS In this retrospective observational study, the echocardiograms of ex-preterm children less than 3 years old who underwent cardiac catheterization at a single institution were reviewed. PVS on cardiac catheterization was defined by a mean pressure gradient of >3mmHg in the pulmonary vein with angiographic evidence of stenosis. Pulmonary vein Doppler waveforms, from echocardiograms performed prior to catheterization, in children with and without PVS were compared. Non-stenosed veins in patients with PVS were excluded. The systolic and diastolic velocities of blood flow, phasic flow and return of the Doppler waveform to baseline were analyzed. RESULTS Forty-seven children were included in the study, 18 children with 25 stenosed pulmonary veins and 29 children with 78 non-stenosed pulmonary veins were analyzed. Stenosed pulmonary veins had higher peak systolic and diastolic velocities, and higher peak and mean pressure gradients as measured by spectral Doppler. Peak systolic and diastolic velocities had an area under the ROC curve of 0.89 (confidence interval: 0.79,0.99) and 0.93 (confidence interval: 0.85 ,0.99) for PVS, respectively, and threshold velocity of 0.7 m/sec had sensitivities of 80% and 84% and specificity of 94%. There was no correlation between Doppler-derived pulmonary vein mean gradient and measured pulmonary vein mean gradient during cardiac catheterization in stenosed pulmonary veins. Presence of phasic flow in the pulmonary vein and return of the Doppler waveform to baseline were associated with a non-stenosed pulmonary vein (sensitivity of 94% and 60% and specificity of 52% and 60%, respectively). CONCLUSIONS Systolic and diastolic Doppler velocities and features of the waveform can discriminate for stenosed pulmonary veins confirmed by cardiac catheterization in ex-preterm children. Our results suggest lower systolic and diastolic Doppler velocities cutoff values than currently published to screen for PVS in ex-preterm children. These cutoff values require validation in prospective studies.
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Affiliation(s)
- Yalin Lin
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Elena K Amin
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Roberta L Keller
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - David F Teitel
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Hythem M Nawaytou
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
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A rare case of congenital pulmonary vein stenosis diagnosed in a young adult and treated with a catheter based intervention. J Heart Lung Transplant 2021; 41:421-423. [PMID: 34974965 DOI: 10.1016/j.healun.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/12/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
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38
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Batra K, Saboo SS, Kandathil A, Canan A, Hedgire SS, Chamarthy MR, Kalva SP, Abbara S. Extrinsic compression of coronary and pulmonary vasculature. Cardiovasc Diagn Ther 2021; 11:1125-1139. [PMID: 34815964 DOI: 10.21037/cdt-20-155] [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: 02/03/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Abstract
Coronary artery disease from atherosclerosis induced stenosis remains the leading cause of acute coronary syndrome (ACS) and death worldwide, however extrinsic compression of coronary arteries from adjacent anatomical and pathological structures is an infrequent but important diagnosis to be aware of, especially given the nonspecific symptoms of chest pain that mimic angina in patients with pulmonary hypertension (PHT) and congenital heart disease. Non-invasive CT angiography is an invaluable diagnostic tool for detection of coronary artery compression, pulmonary artery dilatation and pulmonary vascular compression. Although established guidelines are not available for management of left main coronary artery (LMCA) compression syndrome, percutaneous coronary intervention and stent implantation remain a feasible option for the treatment, specifically for patients with a high surgical risk. Treatment of pulmonary vein or artery compression is more varied and determined by etiology. This review article is focused on detailed discussion of extrinsic compression of coronary arteries, mainly the LMCA and brief discussion on pulmonary vasculature compression by surrounding anatomical and pathological entities, with focus on pathophysiology, clinical features, complications and role of imaging in its diagnosis and management.
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Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Health Science Center, TX, USA
| | - Asha Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arzu Canan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Murthy R Chamarthy
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical, School, Boston, MA, USA
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Affiliation(s)
- Christiane Haeffele
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
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Govea N, Chan J. Airway Hemorrhage During Left Atrial Appendage Exclusion Device Insertion. J Cardiothorac Vasc Anesth 2021; 36:3124-3128. [PMID: 34876351 DOI: 10.1053/j.jvca.2021.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nicolas Govea
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
| | - June Chan
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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Scott CP, Shibbani K, Caldarone CA, McLennan D. This and that: management of Tetralogy of Fallot and pulmonary vein stenosis in an infant—a case report. Eur Heart J Case Rep 2021; 5:ytab429. [PMID: 34859184 PMCID: PMC8633749 DOI: 10.1093/ehjcr/ytab429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/28/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Tetralogy of Fallot (TOF) is the most common congenital cyanotic cardiac lesion. Pulmonary vein stenosis occurs much less commonly and remains difficult to manage. It is exceedingly uncommon for a patient to have both lesions. This case highlights the diagnostic and management difficulties in an infant with these two lesions.
Case summary
The patient is a 4-month-old female infant with a history of TOF status post right ventricular outflow tract stent placement who presented after a hypoxaemic event at home to 40% SpO2. Computed tomography angiography demonstrated previously undiagnosed pulmonary vein stenosis of all four veins. She underwent multiple catheter-based palliations including balloon dilations and stent placements in each pulmonary vein in order to maximize her chances of successful definitive repair. She underwent successful repair of her TOF and pulmonary vein stenosis at ten months of age.
Discussion
The combination of TOF and pulmonary vein stenosis is not common, but when these lesions co-occur, they present a significant dilemma in determining the timing of surgery in order to optimize the odds of a successful outcome. This case demonstrates that serial catheter-based procedures can be valuable tools in minimizing pre-operative risk factors and highlights one strategy in determining timing of definitive surgical repair.
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Affiliation(s)
- Christopher P Scott
- Division of Pediatric Cardiology, Children’s Wisconsin, 8915 W Connell Ct, P.O. Box 1997, Milwaukee, WI, 53226, USA
| | - Kamel Shibbani
- Division of Pediatric Cardiology, University of Iowa Stead Family Children’s Hospital, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Christopher A Caldarone
- Department of Congenital Heart Surgery, Texas Children's Hospital, 6651 Main St, Houston, TX, 77030, USA
| | - Daniel McLennan
- Division of Pediatric Cardiology, Children’s Wisconsin, 8915 W Connell Ct, P.O. Box 1997, Milwaukee, WI, 53226, USA
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Santos Silva F, Arruda Pereira R, Silva MJ. An Unusual Case of Pulmonary Vein Stenosis Diagnosed With Intraoperative Transesophageal Echocardiography. A A Pract 2021; 15:e01515. [PMID: 37956250 DOI: 10.1213/xaa.0000000000001515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Ricardo Arruda Pereira
- Cardiothoracic Surgery Services, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Maria Joana Silva
- Cardiothoracic Surgery Services, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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The Role of Elevated Wall Shear Stress in Progression of Pulmonary Vein Stenosis: Evidence from Two Case Studies. CHILDREN-BASEL 2021; 8:children8090729. [PMID: 34572161 PMCID: PMC8470228 DOI: 10.3390/children8090729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022]
Abstract
Pulmonary vein stenosis is a serious condition characterized by restriction or blockage due to fibrotic tissue ingrowth that develops in the pulmonary veins of infants or children. It is often progressive and can lead to severe pulmonary hypertension and death. Efforts to halt or reverse disease progression include surgery and catheter-based balloon dilation and stent implantation. Its cause and mechanism of progression are unknown. In this pilot study, we propose and explore the hypothesis that elevated wall shear stress at discrete pulmonary venous sites triggers stenosis. To assess this theory, we retrospectively analyzed cardiac catheterization, lung scan, and X-ray computed tomography data to estimate wall shear stress in the pulmonary veins at multiple time points during disease progression in two patients. Results are consistent with the existence of a level of elevated wall shear stress above which the disease is progressive and below which progression is halted. The analysis also suggests the possibility of predicting the target lumen size necessary in a given vein to reduce wall shear stress to normal levels and remove the trigger for stenosis progression.
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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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Zettler E, Rivera BK, Stiver C, Boe B, Cua C, Ball MK, Smith CV, Slaughter JL, Chen B, Callahan R, Backes CH. Primary pulmonary vein stenosis among premature infants with single-vessel disease. J Perinatol 2021; 41:1621-1626. [PMID: 32989220 PMCID: PMC8593792 DOI: 10.1038/s41372-020-00830-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Describe outcomes among preterm infants diagnosed with single-vessel primary pulmonary vein stenosis (PPVS) initially treated using conservative management (active surveillance with deferral of treatment). STUDY DESIGN Retrospective cohort study at a single, tertiary-center (2009-2019) among infants <37 weeks' gestation with single-vessel PPVS. Infants were classified into two categories: disease progression and disease stabilization. Cardiopulmonary outcomes were examined, and a Kaplan-Meier survival analysis performed. RESULTS Twenty infants were included. Compared to infants in the stable group (0/10, 0%), all infants in the progressive group had development of at least severe stenosis or atresia (10/10, 100%; P < 0.01). Severe pulmonary hypertension at diagnosis was increased in the progressive (5/10, 50%) versus the stable group (0/10, 0%; P = 0.03). Survival was lower among infants in the progressive than the stable group (log-rank test, P < 0.01). CONCLUSION Among preterm infants with single-vessel PPVS, risk stratification may be possible, wherein more targeted, individualized therapies could be applied.
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Affiliation(s)
- Eli Zettler
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Corey Stiver
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford Cua
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Charles V Smith
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Bernadette Chen
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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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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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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Talmor N, Massera D, Small A, Ramachandran A, Argilla M, Staniloae CS, Latson LA, Halpern DG. Acquired pulmonary vein stenosis resulting in haemoptysis: a case series. Eur Heart J Case Rep 2021; 5:ytab235. [PMID: 34222784 PMCID: PMC8243221 DOI: 10.1093/ehjcr/ytab235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acquired pulmonary vein stenosis (PVS) is an infrequent complication of atrial fibrillation ablation that is often misdiagnosed due to predominant respiratory symptoms. It can result in pulmonary venous hypertension, with varying presentations, ranging from shortness of breath to haemoptysis. CASE SUMMARY We report two patients with a history of paroxysmal atrial fibrillation treated with radiofrequency ablation and pulmonary vein (PV) isolation, who subsequently developed PVS. Case 1 initially presented with indolent symptoms of shortness of breath and cough. He was initially diagnosed with and treated for pneumonia. In contrast, Case 2 presented with massive haemoptysis, requiring intubation and intensive care unit admission. Both patients were eventually diagnosed with PVS by computed tomography. They were treated with PV angioplasty and stenting. DISCUSSION While previously limited to the congenital heart disease population, PVS is occurring more frequently now in adult patients as a complication of ablation procedures. It is most effectively treated with angioplasty and stent implantation but has a high rate of recurrence.
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Affiliation(s)
- Nina Talmor
- Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Daniele Massera
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Adam Small
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Abhinay Ramachandran
- Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Michael Argilla
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Cezar S Staniloae
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Larry A Latson
- Department of Radiology, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
| | - Dan G Halpern
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, 550 First Ave, New York City, NY 10016, USA
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Bechsgaard T, Midtgaard A, Jakobsen E, Kjeldsen AD. Successful treatment of massive haemoptysis in a young woman with anastomosis of right internal mammary artery to right superior pulmonary vein fistula. BMJ Case Rep 2021; 14:14/5/e240739. [PMID: 34035019 DOI: 10.1136/bcr-2020-240739] [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: 11/03/2022] Open
Abstract
A 21-year-old, otherwise healthy, female patient was admitted with haemoptysis. Chest X-ray and CT found a consolidated right middle pulmonary lobe. Catheter angiography of ascending aorta visualised two hypertrophic and tortuous branches of the right internal mammary artery with a fistula to the right superior pulmonary vein. The inflow was embolised with coils. Catheter angiography of descending aorta found hypertrophic right bronchial arteries and right phrenic artery supplying a web-like network of vessels, which drained to the right superior pulmonary vein with discrete filling of an accessory right middle pulmonary vein. CT angiography with a catheter for contrast administration in the ascending aorta was performed for characterisation. After two additional episodes of haemoptysis, right middle lobe lobectomy was performed. Perioperatively pulmonary artery blood supply to the right middle pulmonary lobe was absent and an atretic accessory middle pulmonary vein was seen. The patient was discharged 7 days afterwards without sequelae.
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Affiliation(s)
| | | | - Erik Jakobsen
- Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark
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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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