BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angio...BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.展开更多
Objectives:Factors influencing results of balloon valvuloplasty(BVP)of pulmonary valve stenosis(PS)in children are investigated.Background:BVP has become the standard of care for PS,medium-term results are not uniform...Objectives:Factors influencing results of balloon valvuloplasty(BVP)of pulmonary valve stenosis(PS)in children are investigated.Background:BVP has become the standard of care for PS,medium-term results are not uniform and depend on various preconditions.Methods:We analysed the medium-term results of BVP of PS in children in an observational,single centre study.Need for additional procedure was defined as outcome after initial BVP.Results:We included 143 children(83 female)at a median(IQR)age of 2.6(0.26–9.24)months and body weight of 5(3.4–8)kg at BVP with a follow–up of 5.04(1.6–10.2)years.We used balloon size of 10(9–14)mm and maximal balloon pressure of 4(3.5–10)atm,resulting in balloon–to–pulmonary annulus ratio of 1.28(1.2–1.4).Systolic pressure gradient of PS was reduced with BVP(43.5 mmHg vs.14.0 mmHg,p<0.001)and confirmed by echocardiography(68.0 mmHg vs.25.0 mmHg,p<0.001)day 1 post procedure.Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients(74.2%).Early additional procedure was necessary in 14 patients(9.8%)after 0.2(0.1–0.7)years due to residual PS(n=13)and infective endocarditis(n=1).Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient,but not genetic syndrome.During further follow–up of 5.04(1.6–10.2)years no further additional procedures were needed.Conclusions:Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results,even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.展开更多
Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim o...Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. Methods： The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms,and echocardiograms before PBPV and at each follow-up.All procedures were performed by more than two experienced operators. Results： Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg （range： 43-151 mmHg） to 24.49 ± 17.00 mmHg （range： 3-92 mmHg; P 〈 0.001） and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg （range： 60-174 mmHg） to 52.07 ± 18.89 mmHg （range： 22-134 mmHg; P 〈 0.001）. Residual transvalvular pressure gradientsof67.31±15.19mmHg（range：50-92mmHg）werefoundin8.2%ofpatients,indicatingpoortherapeuticeffects;6.4%ofpatientshad variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences（P 〈 0.05） among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio （odds ratio： 0.005, 95% confidence interval： 0-0.39） was an independent protective factor for restenosis. The rate of severe complications was 1.9%. Conclusions： PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.展开更多
Background： Pulmonary stenosis is common in children with complex congenital heart diseases. Proper management of this problem, especially postoperatively, is still controversial. This study was designed to assess th...Background： Pulmonary stenosis is common in children with complex congenital heart diseases. Proper management of this problem, especially postoperatively, is still controversial. This study was designed to assess the rate and determinants of success or failure of balloon angioplasty for such lesions. Methods： Clinical and hemodynamic data from 40 pediatric patients （24 boys and 16 girls） with complex congenital heart diseases who underwent balloon angioplasty were reviewed retrospectively from January 2012 to December 2016. Patients were divided into four groups according to the site of stenosis, which included pulmonary valve stenosis （PVS）, valved conduit stenosis, pulmonary artery stenosis （PAS）, and supravalvular pulmonary stenosis （SVPS）. Success rates were calculated according to defined criteria for initial success and favorable clinical impacts, and comparison between the successful subgroup and the unsuccessful subgroups was analyzed. Results： Grouped by the site of stenosis, initial success rates varied from 40.0% to 52.4% with the greatest success being seen in the PVS group, followed by the PAS group and SVPS group. In the PVS group and the PAS group, there was no statistical difference among age at dilation, postoperative interval, balloon/stenosis ratio, or pressure gradient predilation between the successful and the unsuccessful subgroups. Favorable clinical impacts included success rates of balloon angioplasty in the SVPS group, which was best （100%）, followed by the PVS group （90.9%） and the PAS group （85.7%）. There were a total of two transient complications （5.0%）. Conclusions： Balloon angioplasty was proven to be a safe and useful modality in children with complex congenital heart diseases and postoperative pulmonary stenosis, which should be the initial therapeutic modality in selected patients.展开更多
文摘BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
文摘Objectives:Factors influencing results of balloon valvuloplasty(BVP)of pulmonary valve stenosis(PS)in children are investigated.Background:BVP has become the standard of care for PS,medium-term results are not uniform and depend on various preconditions.Methods:We analysed the medium-term results of BVP of PS in children in an observational,single centre study.Need for additional procedure was defined as outcome after initial BVP.Results:We included 143 children(83 female)at a median(IQR)age of 2.6(0.26–9.24)months and body weight of 5(3.4–8)kg at BVP with a follow–up of 5.04(1.6–10.2)years.We used balloon size of 10(9–14)mm and maximal balloon pressure of 4(3.5–10)atm,resulting in balloon–to–pulmonary annulus ratio of 1.28(1.2–1.4).Systolic pressure gradient of PS was reduced with BVP(43.5 mmHg vs.14.0 mmHg,p<0.001)and confirmed by echocardiography(68.0 mmHg vs.25.0 mmHg,p<0.001)day 1 post procedure.Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients(74.2%).Early additional procedure was necessary in 14 patients(9.8%)after 0.2(0.1–0.7)years due to residual PS(n=13)and infective endocarditis(n=1).Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient,but not genetic syndrome.During further follow–up of 5.04(1.6–10.2)years no further additional procedures were needed.Conclusions:Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results,even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.
文摘Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. Methods： The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms,and echocardiograms before PBPV and at each follow-up.All procedures were performed by more than two experienced operators. Results： Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg （range： 43-151 mmHg） to 24.49 ± 17.00 mmHg （range： 3-92 mmHg; P 〈 0.001） and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg （range： 60-174 mmHg） to 52.07 ± 18.89 mmHg （range： 22-134 mmHg; P 〈 0.001）. Residual transvalvular pressure gradientsof67.31±15.19mmHg（range：50-92mmHg）werefoundin8.2%ofpatients,indicatingpoortherapeuticeffects;6.4%ofpatientshad variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences（P 〈 0.05） among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio （odds ratio： 0.005, 95% confidence interval： 0-0.39） was an independent protective factor for restenosis. The rate of severe complications was 1.9%. Conclusions： PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.
文摘Background： Pulmonary stenosis is common in children with complex congenital heart diseases. Proper management of this problem, especially postoperatively, is still controversial. This study was designed to assess the rate and determinants of success or failure of balloon angioplasty for such lesions. Methods： Clinical and hemodynamic data from 40 pediatric patients （24 boys and 16 girls） with complex congenital heart diseases who underwent balloon angioplasty were reviewed retrospectively from January 2012 to December 2016. Patients were divided into four groups according to the site of stenosis, which included pulmonary valve stenosis （PVS）, valved conduit stenosis, pulmonary artery stenosis （PAS）, and supravalvular pulmonary stenosis （SVPS）. Success rates were calculated according to defined criteria for initial success and favorable clinical impacts, and comparison between the successful subgroup and the unsuccessful subgroups was analyzed. Results： Grouped by the site of stenosis, initial success rates varied from 40.0% to 52.4% with the greatest success being seen in the PVS group, followed by the PAS group and SVPS group. In the PVS group and the PAS group, there was no statistical difference among age at dilation, postoperative interval, balloon/stenosis ratio, or pressure gradient predilation between the successful and the unsuccessful subgroups. Favorable clinical impacts included success rates of balloon angioplasty in the SVPS group, which was best （100%）, followed by the PVS group （90.9%） and the PAS group （85.7%）. There were a total of two transient complications （5.0%）. Conclusions： Balloon angioplasty was proven to be a safe and useful modality in children with complex congenital heart diseases and postoperative pulmonary stenosis, which should be the initial therapeutic modality in selected patients.
