Dilation angioplasty of congenital or operative narrowings of venous channels.

Abstract

Balloon dilation angioplasty was attempted in 10 infants and children with severe congenital or operative "venous" obstructions. In five children the obstructions were "vena caval" and followed repair for transposition of the great vessels (four patients) or orthotopic liver transplantation (one patient). In the four patients with fixed vena caval or baffle obstructions, balloon angioplasty was successful in relieving the obstruction, decreasing the average gradient (16.0 to 4.5 mm Hg), and increasing the average diameter (3.0 to 8.9 mm) of the obstructed site. One child died 1 week later from an unrelated cerebral hemorrhage; the three survivors have had persistent clinical and angiographic improvement. The fifth child had severe systolic narrowing of the superior baffle limb caused by marked tricuspid regurgitation, which ballooned the superior limb of the baffle against the atrial roof. Angioplasty was unsuccessful in relieving this type of obstruction, which resolved with tricuspid valve replacement. Of the five infants with obstructed pulmonary veins, three had congenitally narrowed vessels associated with total anomalous pulmonary venous connection, one had acquired stenosis, and one had postoperative obstruction after repair of a mixed type of total anomalous pulmonary venous connection. Dilation was unsuccessful in all five patients, but for different reasons: in the congenitally narrowed veins, the waist in the balloon could not be eliminated, even with high dilating pressures; in the infant with acquired stenosis, the vein stretched but did not tear at low dilating pressures; and in the postoperative obstruction, angioplasty increased the diameter of the obstruction but did not increase flow to the affected lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome.

“…These findings are consistent both with our experimental animal work6 and with some published clinical experience with newborn critical aortic stenosisl6 reporting damage to the-left ventricular outflow tract and aortic valve with oversized balloons. Surprisingly, the BAR in the range of this study did not influence PRG in contrast to our results from many other models and congenital lesions,12 13,[20][21][22][23][24][25][26] in which progressively increasing balloon sizes were also used. Relief of obstruction was mostly associated with recognizable commissural division.…”

A hybrid approach to stabilization and repair of obstructed total anomalous pulmonary venous connection in a critically ill newborn infant

“…Disappointing results have been reported with attempts to relieve pulmonary venous obstruction through catheter-based balloon dilation. 3 To our knowledge, stenting of the anomalous venous pathway has not been reported. In the case presented, ECMO was performed as a lifesaving maneuver prior to establishing the diagnosis.…”

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

“…[23][24][25][26][27][28][29][30][31][32][33][34] Surgical approach has been tried in some instances, with variable results, depending on the technique used, anatomy, and timing of surgery. 24,26,31,34 In children, balloon angioplasty for PVS has been uniformly unsuccessful.…”

“…24,26,31,34 In children, balloon angioplasty for PVS has been uniformly unsuccessful. 32,33 In addition, endovascular stenting of the pulmonary veins in children has met with little clinical success. 25,[27][28][29][30] On the other hand, stent placement in the pulmonary veins after extrinsic compression in adults has yielded some clinical success.…”

“…31,32 Sadr et al 36 have shown that the myofibroblastic neoproliferative process plays a key role in restenosis within congenitally stenotic pulmonary veins. Perhaps future therapies for patients with PVS after RFA could also be targeted at arresting the neoproliferative stage, such as the use of immunosuppressive agents, chemotherapy, and radiation.…”