Congenital Pulmonary Vein Stenosis: Encouraging Mid-term Outcome.
Congenital pulmonary vein stenosis (PVS) is a rare entity with limited outcome literature. Multiple interventional approaches have evolved including surgical and catheterization techniques. Our objective is to report our center experience and to compare short-term and mid-term outcomes among these therapeutic modalities. Retrospective study on 23 patients (n = 23) with PVS that required intervention over the last 13 years (2000-2013). Patients were divided into three groups based on type of initial intervention. Of these, 10 (43.5%) had balloon angioplasty, 3 (13.0 %) had surgical dilation, and 10 (43.5%) had surgical marsupialization. Mortality and number of re-interventions were our primary outcomes. Mean age at diagnosis was 10.9 ± 18.4 months. Mean age at initial intervention was 14.5 ± 18.0 months. Mean pre- and post-initial intervention PVS gradients were 9.2 ± 3.4 and 3.4 ± 2.2 mmHg, respectively. Mean survival time and re-intervention-free survival time were 4.8 ± 4.0 and 2.8 ± 3.4 years. No statistical significance was found between the interventions with respect to survival time (p = 0.52) and re-intervention free time (p = 0.78). High initial pre- and post-intervention gradients were significantly associated with re-intervention-free survival (p = 0.01 and p = 0.03, respectively). Patients with bilateral disease have increased mortality (p = 0.01) and decreased 5-year survival (p = 0.009) compared to patients with unilateral disease irrespective of type of intervention. No statistically significant difference in mortality or re-intervention rate was present among these different therapeutic modalities. This study has the longest follow-up so far reported in the current literature (58 months) with overall survival of 78%.
Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University, 705, Riley Hospital Drive, Indianapolis, IN, 46032, USA. prcharla@iupui.edu.
Pradeepkumar
P
Charlagorla
Indiana University School of Medicine, Indianapolis, IN, 46032, USA.
David
D
Becerra
Indiana University School of Medicine, Indianapolis, IN, 46032, USA.
Parth M
PM
Patel
Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University, 705, Riley Hospital Drive, Indianapolis, IN, 46032, USA.
Mark
M
Hoyer
Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University, 705, Riley Hospital Drive, Indianapolis, IN, 46032, USA.
Robert K
RK
Darragh
D000800:Angioplasty, Balloon / Q000379:methods* / Q000401:mortality; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D011668:Pulmonary Veno-Occlusive Disease / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
Balloon angioplasty; Congenital pulmonary vein stenosis; Marsupialization; Pulmonary hypertension; Surgical dilation