Background Fibrosing Mediastinitis (FM) is a rare complication of infection with Histoplasma capsulatum, which can lead to obstruction of pulmonary and systemic vasculature and large airways, often resulting in significant morbidity and mortality. Medical therapy is ineffective and surgical intervention is often not feasible. Stent implantation offers a potential treatment for vascular obstruction due to FM, but this has not been well studied. Methods and Results We conducted a retrospective review of all patients undergoing cardiac catheterization for FM. Anatomic site of stenosis and hemodynamic information before and after intervention, as well as clinical presentation and follow-up data were recorded. From 1996 to 2008, 58 patients underwent cardiac catheterization for FM, with intervention performed in 40 (69%). A total of 77 stents were used to relieve 59 lesions (pulmonary artery = 26, pulmonary vein = 21, superior vena cava = 12). Significant reduction in pressure gradients (p<0.001) and increase in vessel caliber (p<0.001) was seen at all locations. Symptomatic recurrent stenosis requiring further intervention occurred in 11 (28%) patients. Median time to recurrence was 115 months. Thirty-two (87%) of 37 patients for whom follow-up was available reported symptomatic improvement following stent placement. Procedure-related complications occurred in 14 patients (24%). Overall mortality was 19%, with the majority of deaths in patients with bilateral disease. Among patients with bilateral disease, intervention was associated with improved survival at 5 years. Conclusions Percutaneous vascular stent implantation is an effective therapy for central vascular obstruction due to FM, providing significant relief of anatomic obstruction and sustained clinical improvement.

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ObjectivesTo assess safety, efficacy, and intermediate term outcomes of percutaneous interventions in Mustard patients.BackgroundBaffle leaks and obstruction are present in 20% of Mustard survivors. Surgical reintervention is associated with high mortality.MethodsRetrospective review of percutaneous interventions performed at three adult congenital catheterization programs.ResultsOverall, 26 catheterizations and 29 interventions were performed in 22 patients (mean age 32.4 ± 8.3 years). Previous laser pacemaker lead extraction was successful in seven of seven procedures where the lead was at risk. Stent placement was successful in all 18 patients with systemic venous baffle (SVB) obstruction (mean gradient: 6.2 ± 3.4–0.6 ± 1.0 mm Hg; P < 0.01, narrowest diameter 4.5 ± 4.5–17.1 ± 3.9 mm; P < 0.01). Balloon angioplasty was performed in two patients for pulmonary venous baffle (PVB) obstruction with mixed results. Baffle leak interventions included device occlusion (n = 6), coil occlusion (n = 1), and covered stent occlusion (n = 3). Postprocedural residual leaks were demonstrated in three of eight. In two of the three the residual leak was not appreciable at 1‐year follow‐up. No patient experienced leak or obstruction related symptom recurrence (mean follow‐up: 33.4 ± 29.5 months). Complications included one death secondary to ventricular arrhythmia 2 days after PVB angioplasty and device related inferior SVB obstruction with resolution following stent placement.ConclusionsStent placement for SVB obstruction following Mustard repair is effective and likely safer than surgical intervention. Baffle leak occlusion can be safely accomplished but residual leaks are common in the short term. © 2012 Wiley Periodicals Inc.