No abstract available.
Hypertension, Pulmonary* ; Pulmonary Veno-Occlusive Disease*

Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; adverse effects ; Humans ; Male ; Pulmonary Veno-Occlusive Disease ; etiology ; therapy

Adult ; Echocardiography, Doppler, Color ; Female ; Humans ; Hypertension, Pulmonary ; etiology ; Pulmonary Veno-Occlusive Disease ; complications ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the feasibility, safety, and effectiveness of pulmonary vein stenting in patients with severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF).

METHODSThis retrospective analysis included 5 PVS patients (3 males, (54.1 ± 11.2) years old) confirmed by computed tomography angiography after catheter ablation of AF in Shanghai Chest Hospital from April 2010 to April 2013. After selective pulmonary vein angiography, stents were implanted in the pulmonary vein. Operation results were analyzed after the procedure.

RESULTSAll of 14 serious pulmonary vein stenosis from these 5 patients were treated with primary stent implantation (diameter: 7 or 8 mm, length: 12-23 mm). After stenting, degree of pulmonary vein stenosis decreased from (83 ± 16) % to (12 ± 4) % (P < 0.01), the minimal diameter of the stenosis was significantly increased from (1.7 ± 0.6) mm to (8.1 ± 0.7) mm (P < 0.01), trans-stenotic gradient decreased from (15 ± 5) mmHg (1 mmHg = 0.133 kPa) to (3 ± 2) mmHg (P < 0.05), mean pulmonary pressure measured by cardiac catheter decreased from (47 ± 5) mmHg to (28 ± 4) mmHg (P < 0.05). Dyspnea was improved after the procedure. There was no serious operation related complications. Six months after stenting, three patients still complained mild to moderate dyspnea, and in-stent restenosis was evidenced in seven pulmonary veins by computed tomography angiography. These stenosis was successfully dilated by repeated interventions with balloon dilation.

CONCLUSIONSStenting for severe pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation may be feasible and safe, and can improve hemodynamics and symptoms. In-stent stenosis is relatively frequent, and larger stents and early intervention may reduce the rates of in-stent restenosis.

Aged ; Atrial Fibrillation ; therapy ; Cardiac Catheters ; Catheter Ablation ; China ; Constriction, Pathologic ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Veins ; Pulmonary Veno-Occlusive Disease ; therapy ; Retrospective Studies ; Stents ; Vascular Diseases

Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension in which the primary abnormality is obliterative obstruction of pulmonary veins, especially venules. Clinicaly, we should suspect this disease in the case of congestive cardiac failure with pulmonary hypertension, chronic interstitial pulmonary edema, and normal or elevated wedge pressure on cardiac catheterization. We experience a case of pulmonary hypertension due to pulmonary veno-occlusive disease. A 55-years -old woman developed progressive dry cough and dyspnea for 3 months. Physical examination showed normal heart sounds, diffuse crackles in the whole lung fields. The liver was not palpable and pitting edema was absent. The diagnosis was made by chest HRCT, 2-D echocardiography, normal pulmonary capillary wedge pressure on cardiac catheterization, and confirmed by thoracoscopic lung biopsy. This patient was treated with vasodilator(calcium antagonist) and with mild symptomatic improvement. We reported a case of pulmonary veno-occlusive disease with review of literatures.
Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Cough ; Diagnosis ; Dyspnea ; Echocardiography ; Edema ; Estrogens, Conjugated (USP) ; Female ; Heart Failure ; Heart Sounds ; Humans ; Hypertension, Pulmonary ; Liver ; Lung ; Physical Examination ; Pulmonary Edema ; Pulmonary Veins ; Pulmonary Veno-Occlusive Disease* ; Pulmonary Wedge Pressure ; Respiratory Sounds ; Thorax ; Venules

BACKGROUND: Experimental studies of vascular remodeling in the pulmonary arteries have been performed actively. These models required a persistent vascular insult for intimal injury induced by chronic hypoxia, monocrotaline intoxication or chronic air embolism and characterized medial hypertrophy and neointimal formation by active synthesis of the extracellular matrix protein. The purpose of this study was to determine the pattern of pulmonary vascular remodeling after obstruction of the pulmonary vein. MATERIAL AND METHOD: Obstruction of the right pulmonary vein with a metal clip was performed in Sprague-Dawley rats (352+/-18 g, n=10) to cause pulmonary vascular disease. Fifteen days later, experimental studies were done and finally the both lungs and hearts were extirpated for experimental measurement. Pulmonary arterial pressure, weight ratio of right ventricle (RV) to left ventricle (LV) and ventricular septum (S) (RV/LV+S weight ratio), and pulmonary artery morphology (percent wall thickness, %WT) were evaluated and compared with normal control groups. RESULT: Pulmonary hypertension (38+/-12 mmHg vs 13+/-4 mmHg; p<0.05) and right ventricular hypertrophy (right ventricular/left ventricular and septal weight ratio, 0.52+/-0.07 vs 0.35+/-0.04; p<0.05) with hypertrophy of the muscular layer of the pulmonary arterial wall (percent wall thickness, 22.4+/-6.7% vs 6.7+/-3.4%; p<0.05) were developed by 15 days after obstruction of the pulmonary vein. CONCLUSION: Obstruction of the pulmonary vein developed elevation of pulmonary blood pressure and medial hypertrophy of the pulmonary artery. These results are a part of the characteristic vascular remodeling. Theses results demonstrate that obstruction of the pulmonary vein can develope not only high pulmoanry blood flow of contralateral lung but also intima injury inducing vascular remodeling.
Animals ; Anoxia ; Arterial Pressure ; Blood Pressure ; Embolism, Air ; Extracellular Matrix ; Heart ; Heart Ventricles ; Hypertension, Pulmonary* ; Hypertrophy ; Hypertrophy, Right Ventricular ; Lung* ; Monocrotaline ; Pulmonary Artery ; Pulmonary Veins* ; Pulmonary Veno-Occlusive Disease ; Rats* ; Rats, Sprague-Dawley ; Vascular Diseases ; Ventricular Septum

OBJECTIVETo investigate the clinical presentation, diagnosis, treatment and outcome of patients with pulmonary veno-occlusive disease (PVOD).

METHODSData from patients diagnosed as PVOD from May 2008 to May 2011 in Shanghai Pulmonary Hospital, Tongji University were retrospectively reviewed.

RESULTSDuring this period, 5 patients [4 female, aged from 12 to 42 (22 ± 12) years old] were diagnosed as PVOD. The durations from symptoms onset to PVOD diagnosis was 2 to 50 (16 ± 20) months and four of them were previously diagnosed as idiopathic pulmonary arterial hypertension. All patients at the time of PVOD diagnosis had a severely impaired WHO pulmonary hypertension functional class (3 in class III and 2 in class IV). Furthermore, all patients characterized by a typical sign of centrilobular ground-glass opacities in high-resolution computed tomography, a markedly reduction of diffusing capacity of the lung for carbon monoxide [(38 ± 12)% of predicted value] in pulmonary functional test and severely compromised cardio-pulmonary hemodynamics identified by right heart catheterization. All patients received conventional and pulmonary arterial hypertension specific therapies, and then followed-up regularly. Up to now, 4 out of 5 patients died due to refractory right heart failure. The durations from symptoms onset to death and from PVOD establish to death were 5 - 65 (27 ± 26) months and 1 - 16 (9 ± 9) months, respectively.

CONCLUSIONSPVOD is a rare and malignant cardio-pulmonary disorder that often be misdiagnosed as idiopathic pulmonary arterial hypertension. Given the poor responses to modern pulmonary arterial hypertension specific therapies, lung transplantation remains the treatment of choice.

Adolescent ; Adult ; Cardiac Catheterization ; China ; Diagnostic Errors ; Familial Primary Pulmonary Hypertension ; pathology ; therapy ; Female ; Hemodynamics ; Humans ; Lung ; Lung Transplantation ; Male ; Pulmonary Veno-Occlusive Disease ; diagnosis ; pathology ; therapy ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult