Pediatric Cardiology

, Volume 33, Issue 1, pp 109–114

Cryo-Balloon Angioplasty for Pulmonary Vein Stenosis in Pediatric Patients

  • Michael A. Bingler
  • Jeffrey R. Darst
  • Thomas E. Fagan
Original Article

Abstract

This study sought to determine the safety and effectiveness of cryo-balloon angioplasty (CbA) for pulmonary vein stenosis (PVS) in pediatric patients. Current therapy options for PVS are less than satisfactory due to recurrent progressive restenosis and neointimal proliferation. Catheterization database, hospital records, imaging studies, and pathologic specimens were reviewed for procedural-related and outcomes data in all patients who underwent pulmonary vein (PV) CbA using the Boston Scientific PolarCath Peripheral Dilation System between August 2006 and June 2009. Thirteen patients (19 PVs; median age 13 months [range 3.5 months to 18.5 years] and weight 7.9 kg [range 3.8 to 47.7]) underwent CbA. Mean PVS diameter after CbA increased from 2.19 (±0.6) to 3.77 (±1.1) mm (p < 0.001). Mean gradient decreased from 14 (±7.4) to 4.89 (±3.2) mm Hg (p < 0.001). Mean stenosis–to–normal vein diameter ratio increased from 0.52 (±0.15) to 0.89 (±0.33) (p < 0.001). Eight patients underwent repeat catheterization a mean of 5.6 months (±3.66) later. Improved PVS diameter was maintained in 2 PVs. Four veins had restenosis but maintained diameters greater than that before initial CbA. In 11 PVs, the diameter decreased from 4.28 (±1.14) to 2.53 (±0.9) mm (p = 0.001). Mean gradient increased from 3.55 (±3.0) to 14.63 (±9.6) mm Hg (p = 0.011). All vessels underwent repeat intervention with acute relief of PVS. Stroke occurred within 24 h of CbA in 1 patient. CbA of PVS is safe and results in acute relief of stenosis. However, CbA appears minimally effective as the sole therapy in maintaining long-term relief of PVS.

Keywords

Pulmonary vein stenosis Cryo-balloon angioplasty Balloon angioplasty Pulmonary vein angioplasty 

References

  1. 1.
    Cullen S, Ho SY, Shore D, Lincoln C, Reddington A (1994) Congenital stenosis of pulmonary veins―failure to modify natural history by intraoperative placement of stents. Cardiol Young 4:395–398CrossRefGoogle Scholar
  2. 2.
    Devaney EJ, Chang AC, Ohye RG, Bove EL (2006) Management of congenital and acquired pulmonary vein stenosis. Ann Thorac Surg 81(3):992–995PubMedCrossRefGoogle Scholar
  3. 3.
    Dragulescu A, Ghez O, Quilici J, Fraisse A (2009) Paclitaxel drug-eluting stent placement for pulmonary vein stenosis as a bridge to heart–lung transplantation. Pediatr Cardiol 30(8):1169–1171PubMedCrossRefGoogle Scholar
  4. 4.
    Driscoll DJ, Hesslein PS, Mullins CE (1982) Congenital stenosis of individual veins: clinical spectrum and unsuccessful treatment by transvenous balloon pulmonary dilation. Am J Cardiol 49(7):1767–1772PubMedCrossRefGoogle Scholar
  5. 5.
    Drossner DM, Kim DW, Maher KO, Mahle WT (2008) Pulmonary vein stenosis: prematurity and associated conditions. Pediatrics 122:e656–e661PubMedCrossRefGoogle Scholar
  6. 6.
    Edwards J (1960) Congenital stenosis of pulmonary veins. Pathologic and developmental considerations. Lab Invest 9:46–66PubMedGoogle Scholar
  7. 7.
    Fava M, Loyola S, Polydorou A et al (2004) Cryoplasty for femoropopliteal arterial disease: late angiographic results of initial human experience. J Vasc Interv Radiol 15:1239–1243PubMedGoogle Scholar
  8. 8.
    Gordon BM, Moore JW (2010) Treatment of pulmonary vein stenosis with expanded polytetrafluoroethylene covered stents. Catheter Cardiovasc Interv 75:263–267PubMedCrossRefGoogle Scholar
  9. 9.
    Holt DB, Moller JH, Larson S, Johnson MC (2007) Primary pulmonary vein stenosis. Am J Cardiol 99:568–572PubMedCrossRefGoogle Scholar
  10. 10.
    Jefferies JL, Dougherty K, Krajcer Z (2008) First use of cryoplasty to treat in-stent renal artery stenosis. Tex Heart Inst J 35(3):352–355PubMedGoogle Scholar
  11. 11.
    Jenkins KJ, Sanders SP, Orav EJ, Coleman EA, Mayer JE Jr, Colan SD (1993) Individual pulmonary vein size and survival in infants with totally anomalous pulmonary venous connection. J Am Coll Cardiol 22(1):201–206PubMedCrossRefGoogle Scholar
  12. 12.
    Jenkins KJ, Tan PE, Perry SB, et al (2001) Proliferative pulmonary vein stenosis: variable patterns of progression and preliminary results using adjunct chemotherapy. Circulation 104(Suppl II)Google Scholar
  13. 13.
    Karthik S, Tuite DJ, Nicholson AA et al (2007) Cryoplasty for arterial restenosis. Eur J Vasc Endovasc Surg 33:e40–e43CrossRefGoogle Scholar
  14. 14.
    Kataoka T, Honda Y, Bonneau HN, Yock PG, Fitzgerald PJ (2002) New catheter-based technology for the treatment of restenosis. J Interv Cardiol 15(5):e371–e379CrossRefGoogle Scholar
  15. 15.
    Lacour-Gayet F, Rey C, Planche C (1966) Pulmonary vein stenosis. Description of a sutureless surgical procedure using the pericardium in situ. Arch Mal Coeur Vaiss 89(5):633–636Google Scholar
  16. 16.
    Latson LA, Prieto LR (2007) Congenital and acquired pulmonary vein stenosis. Circulation 115:103–108PubMedCrossRefGoogle Scholar
  17. 17.
    McMahon CJ, Mullins CC, El Said HG (2003) Intrastent sonotherapy in pulmonary vein restenosis: a new treatment for a recalcitrant problem. Heart 89:e6PubMedCrossRefGoogle Scholar
  18. 18.
    McMahon C, McDermott M, Walsh K (2006) Failure of cutting balloon angioplasty to prevent restenosis in childhood pulmonary venous stenosis. Catheter Cardiovasc Interv 68:763–766PubMedCrossRefGoogle Scholar
  19. 19.
    Najm HK, Caldarone CA, Smallhorn J, Coles JG (1998) A sutureless technique for the relief of pulmonary vein stenosis with the use of in situ pericardium. J Thorac Cardiovasc Surg 115(2):468–470PubMedCrossRefGoogle Scholar
  20. 20.
    Peng LF, Lock JE, Nugent AW, Jenkins KJ, McElhinney DB (2010) Comparison of conventional and cutting balloon angioplasty for congenital and postoperative pulmonary vein stenosis in infants and young children. Catheter Cardiovasc Interv 75:1084–1090PubMedGoogle Scholar
  21. 21.
    Prieto LR, Schoenhagen P, Arruda MJ, Natale A, Worley SE (2008) Comparison of stent versus balloon angioplasty for pulmonary vein stenosis complicating pulmonary vein isolation. J Cardiovasc Electrophysiol 19(7):673–678PubMedCrossRefGoogle Scholar
  22. 22.
    Qureshi AM, Prieto LR, Latson LA et al (2003) Transcatheter angioplasty for acquired pulmonary vein stenosis after radiofrequency ablation. Circulation 108:1336–1342PubMedCrossRefGoogle Scholar
  23. 23.
    Reidlinger WF, Juraszek AL, Jenkins KJ et al (2006) Pulmonary vein stenosis: expression of receptor tyrosine kinases by lesional cells. Cardiovasc Pathol 5:91–99CrossRefGoogle Scholar
  24. 24.
    Seale AN, Daubeney PE, Magee AG, Rigby ML (2006) Pulmonary vein stenosis: initial experience with cutting balloon angioplasty. Heart 92(6):815–820PubMedCrossRefGoogle Scholar
  25. 25.
    Seale AN, Webber SA, Uemura H et al (2009) Pulmonary vein stenosis: the UK, Ireland and Sweden Collaborative Study. Heart 95(23):1944–1999PubMedCrossRefGoogle Scholar
  26. 26.
    Tomita H, Watanabe K, Yazak S et al (2003) Stent implantation and subsequent dilatation for pulmonary vein stenosis in pediatric patients―maximizing effectiveness. Circ J 67:187–190PubMedCrossRefGoogle Scholar
  27. 27.
    Wildgruber MG, Berger HJ (2008) Cryoplasty for the prevention of arterial restenosis. Cardiovasc Intervent Radiol 31:1050–1058PubMedCrossRefGoogle Scholar
  28. 28.
    Yun TJ, Coles JG, Konstantinov IE et al (2005) Conventional and sutureless techniques for management of the pulmonary veins: evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg 129(1):167–174PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Michael A. Bingler
    • 1
  • Jeffrey R. Darst
    • 2
  • Thomas E. Fagan
    • 2
  1. 1.Children’s Mercy HospitalKansas CityUSA
  2. 2.Pediatric CardiologyUniversity of ColoradoDenverUSA

Personalised recommendations