Short-term efficacy and perioperative safety of catheter-based intervention for pulmonary vein stenosis caused by fibrosing mediastinitis.
10.3760/cma.j.cn112148-20210507-00398
- VernacularTitle:经皮肺静脉成形术治疗纤维纵隔炎所致肺静脉狭窄的短期疗效及安全性探讨
- Author:
Yi Chao DUAN
1
;
Hong Ling SU
1
;
Rong WEI
1
;
Kai Yu JIANG
1
;
A Qian WANG
1
;
Yuan Hua YANG
2
;
Xin PAN
3
;
Yan ZHANG
4
;
Yun Shan CAO
1
Author Information
1. Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China.
2. Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
3. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
4. Tianjin Medical University Eye Hospital, Translational Medicine Laboratory, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China.
- Publication Type:Journal Article
- MeSH:
Angioplasty, Balloon;
Catheters;
Humans;
Male;
Mediastinitis;
Retrospective Studies;
Sclerosis;
Stenosis, Pulmonary Vein;
Stents;
Treatment Outcome
- From:
Chinese Journal of Cardiology
2022;50(1):55-61
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the short-term efficacy and perioperative safety of catheter-based intervention in patients with pulmonary vein stenosis caused by fibrosing mediastinitis (FM). Methods: It was a case series study. Consecutive patients with pulmonary vein stenosis caused by FM, who underwent percutaneous pulmonary vein angioplasty in Gansu Provincial Hospital from January 2018 to June 2020, were retrospective enrolled. The baseline characteristics, comorbidities, exercise capacity and hemodynamic data before and after treatment were compared, and the procedural related complications were evaluated. Results: A total of 30 patients ((64.3±7.1) years, 15 males) were included. Sixty-three pulmonary vein stenosis were treated by 32 percutaneous pulmonary vein angioplasty procedures. Forty-four stents were implanted in 41 pulmonary veins after balloon angioplasty, and the diameter of implanted stents was (8.3±1.2)mm. Balloon angioplasty was performed on 22 pulmonary vein stenosis, the mean balloon diameter was (4.2±2.1)mm. The pulmonary vein diameter increased from (2.6±1.3) to (6.6±2.6) mm (P<0.001) and the pressure gradient across the pulmonary vein stenotic segment reduced from 19 (12, 29) to 2 (0, 4) mmHg (1 mmHg=0.133 kPa) (P<0.001) immediately post procedure. The pulmonary vein flow grade was significantly improved compared with baseline (P<0.001). The most common operation related complications were lung injury (44.0% (11/25)) and hemoptysis (18.8% (6/32)), which did not need special treatment. During the 2.0 (1.3, 3.2) months follow-up, the WHO functional class was significantly improved (P<0.05), the 6-minute walking distance increased from (254.8±114.5) m to (342.8±72.4)m (P<0.05), the mean pulmonary arterial pressure decreased from (40.9±8.3) mmHg to (35.4±7.7) mmHg (P<0.01), 17 out of 19 patients with refractory pleural effusion experienced total remission during the follow-up period (P<0.001). CT pulmonary venography was repeated in 17 patients. The incidence of in-stent restenosis of pulmonary vein was 24.0% (6/25). Conclusions: Percutaneous pulmonary vein angioplasty is effective for the treatment of pulmonary vein stenosis caused by fibrosing mediastinitis. However, it's not so safe, procedural related complication should be paid attention to and the rate of in-stent restenosis is relative high during the short-term follow-up.
