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Christopher A. Caldarone - One of the best experts on this subject based on the ideXlab platform.
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Primary Pulmonary Vein Stenosis: The impact of sutureless repair on survival
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Nicola Viola, John G Coles, Abdullah A. Alghamdi, Donald G. Perrin, Gregory J. Wilson, Christopher A. CaldaroneAbstract:Background Primary Pulmonary Vein Stenosis is often associated with relentless reStenosis and early death. During the last 2 decades, we have developed a sutureless repair to improve prognosis. Methods Hospital records for patients undergoing repair of primary Pulmonary Vein Stenosis from 1989 to 2008 were reviewed. Pulmonary Vein Stenosis was quantified with a Pulmonary Vein Stenosis score. Survival was determined by Kaplan–Meier analysis. Results Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic Pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A sutureless technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total Pulmonary Vein Stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative Pulmonary Vein Stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P Conclusions Mortality and reStenosis rates remained high despite the adoption of a sutureless technique. A preoperative Pulmonary Vein Stenosis score of greater than 4 was a strong predictor of poor prognosis.
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conventional and sutureless techniques for management of the Pulmonary Veins evolution of indications from postrepair Pulmonary Vein Stenosis to primary Pulmonary Vein anomalies
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: John G Coles, Osman O Alradi, Vitor C Guerra, Nilto C De Oliveira, Jeffrey F Smallhorn, Rachel M. Wald, William G Williams, Glen S Van Arsdell, Igor E Konstantinov, Christopher A. CaldaroneAbstract:Objective We have previously reported a limited but favorable experience with a novel sutureless technique for surgical management of postoperative Pulmonary Vein Stenosis occurring after repair of total anomalous Pulmonary venous drainage. Because this technique requires integrity of the retrocardiac space for hemostasis, extension of the technique to the primary repair of Pulmonary Vein anomalies requires evaluation. This analysis reviews our experience with the sutureless technique in patients with postrepair Pulmonary Vein Stenosis, as well as our extension of the technique into primary repair of Pulmonary Vein anomalies. Methods Retrospective univariable-multivariable analysis of all Pulmonary Vein Stenosis procedures and sutureless Pulmonary Vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death. Results Sixty patients underwent 73 procedures, with Pulmonary Vein Stenosis present in 65 procedures. The sutureless technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the sutureless technique for patients with postrepair Pulmonary Vein Stenosis ( P = .04). By using multivariable analysis, a higher Pulmonary Vein Stenosis score was associated with greater risk of reoperation or death. After adjustment, the sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the sutureless technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified. Conclusion The sutureless technique for postrepair Pulmonary Vein Stenosis is associated with encouraging midterm results. Extension of the indications for the technique to primary repair appears safe with the development of simple intraoperative maneuvers.
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Relentless Pulmonary Vein Stenosis after repair of total anomalous Pulmonary venous drainage
The Annals of Thoracic Surgery, 1998Co-Authors: Christopher A. Caldarone, Jeffrey F Smallhorn, William G Williams, Hani K. Najm, Margit Kadletz, Robert M. Freedom, John G ColesAbstract:Abstract Background . Progressive Stenosis of the Pulmonary Veins after repair of total anomalous Pulmonary venous drainage is frequently refractory to surgical therapy. Methods . Retrospective review of 170 consecutive patients treated for total anomalous Pulmonary venous drainage identified 13 patients with postrepair Pulmonary Vein Stenosis. Preoperative and operative data were analyzed to define the patterns of progression and efficacy of surgical techniques. Results . Seventeen reoperations were performed in 13 patients. Postrepair Pulmonary Vein Stenosis was most common in the infracardiac and mixed subtypes ( p p Conclusions . In unilateral Stenosis, progression of disease may be survivable with loss of single-lung perfusion. Although bilateral disease is lethal in most cases, creation of a sutureless neoatrium has demonstrated short-term freedom from disease progression.
John G Coles - One of the best experts on this subject based on the ideXlab platform.
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Primary Pulmonary Vein Stenosis: The impact of sutureless repair on survival
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Nicola Viola, John G Coles, Abdullah A. Alghamdi, Donald G. Perrin, Gregory J. Wilson, Christopher A. CaldaroneAbstract:Background Primary Pulmonary Vein Stenosis is often associated with relentless reStenosis and early death. During the last 2 decades, we have developed a sutureless repair to improve prognosis. Methods Hospital records for patients undergoing repair of primary Pulmonary Vein Stenosis from 1989 to 2008 were reviewed. Pulmonary Vein Stenosis was quantified with a Pulmonary Vein Stenosis score. Survival was determined by Kaplan–Meier analysis. Results Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic Pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A sutureless technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total Pulmonary Vein Stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative Pulmonary Vein Stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P Conclusions Mortality and reStenosis rates remained high despite the adoption of a sutureless technique. A preoperative Pulmonary Vein Stenosis score of greater than 4 was a strong predictor of poor prognosis.
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conventional and sutureless techniques for management of the Pulmonary Veins evolution of indications from postrepair Pulmonary Vein Stenosis to primary Pulmonary Vein anomalies
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: John G Coles, Osman O Alradi, Vitor C Guerra, Nilto C De Oliveira, Jeffrey F Smallhorn, Rachel M. Wald, William G Williams, Glen S Van Arsdell, Igor E Konstantinov, Christopher A. CaldaroneAbstract:Objective We have previously reported a limited but favorable experience with a novel sutureless technique for surgical management of postoperative Pulmonary Vein Stenosis occurring after repair of total anomalous Pulmonary venous drainage. Because this technique requires integrity of the retrocardiac space for hemostasis, extension of the technique to the primary repair of Pulmonary Vein anomalies requires evaluation. This analysis reviews our experience with the sutureless technique in patients with postrepair Pulmonary Vein Stenosis, as well as our extension of the technique into primary repair of Pulmonary Vein anomalies. Methods Retrospective univariable-multivariable analysis of all Pulmonary Vein Stenosis procedures and sutureless Pulmonary Vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death. Results Sixty patients underwent 73 procedures, with Pulmonary Vein Stenosis present in 65 procedures. The sutureless technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the sutureless technique for patients with postrepair Pulmonary Vein Stenosis ( P = .04). By using multivariable analysis, a higher Pulmonary Vein Stenosis score was associated with greater risk of reoperation or death. After adjustment, the sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the sutureless technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified. Conclusion The sutureless technique for postrepair Pulmonary Vein Stenosis is associated with encouraging midterm results. Extension of the indications for the technique to primary repair appears safe with the development of simple intraoperative maneuvers.
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Relentless Pulmonary Vein Stenosis after repair of total anomalous Pulmonary venous drainage
The Annals of Thoracic Surgery, 1998Co-Authors: Christopher A. Caldarone, Jeffrey F Smallhorn, William G Williams, Hani K. Najm, Margit Kadletz, Robert M. Freedom, John G ColesAbstract:Abstract Background . Progressive Stenosis of the Pulmonary Veins after repair of total anomalous Pulmonary venous drainage is frequently refractory to surgical therapy. Methods . Retrospective review of 170 consecutive patients treated for total anomalous Pulmonary venous drainage identified 13 patients with postrepair Pulmonary Vein Stenosis. Preoperative and operative data were analyzed to define the patterns of progression and efficacy of surgical techniques. Results . Seventeen reoperations were performed in 13 patients. Postrepair Pulmonary Vein Stenosis was most common in the infracardiac and mixed subtypes ( p p Conclusions . In unilateral Stenosis, progression of disease may be survivable with loss of single-lung perfusion. Although bilateral disease is lethal in most cases, creation of a sutureless neoatrium has demonstrated short-term freedom from disease progression.
Douglas L. Packer - One of the best experts on this subject based on the ideXlab platform.
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severe Pulmonary Vein Stenosis resulting from ablation for atrial fibrillation
Circulation, 2016Co-Authors: Erin A. Fender, Kristi H. Monahan, David R. Holmes, Jay R Widmer, David O Hodge, George M Cooper, Laurie A Peterson, Douglas L. PackerAbstract:Background:The frequency of Pulmonary Vein Stenosis (PVS) after ablation for atrial fibrillation has decreased, but it remains a highly morbid condition. Although treatment strategies including pul...
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Pulmonary Vein Stenosis after atrial fibrillation ablation.
EuroIntervention, 2016Co-Authors: Erin A. Fender, Douglas L. Packer, David R. HolmesAbstract:Pulmonary Vein Stenosis (PVS) is an uncommon but devastating complication of atrial fibrillation (AF) ablation. Patients are often misdiagnosed due to non-specific symptoms and the challenges of visualising the Pulmonary Veins on standard chest imaging. Delays in treatment result in worsening symptoms and Pulmonary venous occlusion. The optimal method of intervening for PVS has not been well established. ReStenosis after successful intervention is common, warrants active surveillance, and is the focus of research into prevention and management strategies. In this article we review the existing literature on PVS, and discuss our own experience in managing patients with severe PVS.
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TCT-739 Management of Recurrent Pulmonary Vein Stenosis
Journal of the American College of Cardiology, 2015Co-Authors: Erin A. Fender, R. Jay Widmer, Kristi H. Monahan, Laura A. Peterson, David R. Holmes, Douglas L. PackerAbstract:One to five percent of AF ablations may be complicated by Pulmonary Vein Stenosis (PVS). Initial management of high grade Stenosis is performed with balloon angioplasty or stents. ReStenosis occurs frequently. We sought to assess our center's outcomes in patients with reStenosis following an
Lourdes R Prieto - One of the best experts on this subject based on the ideXlab platform.
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Radiologic review of acquired Pulmonary Vein Stenosis in adults.
Cardiovascular Diagnosis and Therapy, 2018Co-Authors: Mauricio S. Galizia, Lourdes R Prieto, Rahul D. Renapurkar, Michael A. Bolen, Joseph T. Azok, Charles T. Lau, Ahmed H. El-sheriefAbstract:Acquired Pulmonary Vein Stenosis (PVS) is an uncommon occurrence in adults, but one that carries significant morbidity/mortality. PVS can be secondary to neoplastic infiltration/extrinsic compression, non-neoplastic infiltration/extrinsic compression, or iatrogenic intervention. This article: (I) reviews the common causes of acquired PVS; (II) illustrates direct and indirect cross-sectional imaging findings in acquired PVS (in order to avoid misinterpretation of these imaging findings); and (III) details the role of imaging before and after the treatment of acquired PVS.
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congenital and acquired Pulmonary Vein Stenosis
Circulation, 2006Co-Authors: Larry A Latson, Lourdes R PrietoAbstract:Pulmonary Vein Stenosis is a fascinating yet frustrating and difficult to manage condition with an exceptionally high mortality rate. Until recently, the disease was seen almost exclusively in young children with or without various forms of congenital heart disease. Pulmonary Vein Stenosis is a relatively rare condition. In most published series from large centers, there has been an average of ≈2 or 3 cases per year that require treatment. Pulmonary Vein Stenosis in the adult population is even more rare, and the small number of reported cases has often been associated with mediastinal processes such as neoplasms or fibrosing mediastinitis. However, with the advent of aggressive treatment strategies for atrial fibrillation, we have seen a new group of Pulmonary Vein Stenosis patients. The Stenosis appears as a complication of radiofrequency ablation procedures around the Pulmonary Veins. Small series of new surgical and interventional catheterization procedures for treatment of both the pediatric and adult forms of Pulmonary Vein Stenosis suggest an improving prognosis in centers with specialized expertise. However, the prognosis of patients affected with Pulmonary Vein Stenosis remains guarded and requires diligent follow-up and often repeated procedures. The purpose of this article is to review concepts of causation and possible treatments for this rare but serious condition as they evolve. The left atrium and Pulmonary Veins initially develop separately in the 3- to 5-mm embryo (25 to 27 days gestation).1 The primordial Pulmonary venous system is part of the splanchnic plexus, which initially connects to the cardinal and umbilicovitelline Veins. At 27 to 29 days gestation, a small endothelial outgrowth from the posterior superior wall of the primordial left atrium develops just to the left of the developing septum primum. At 28 to 30 days gestation, this common Pulmonary venous out-pouching engages the Pulmonary venous portion of the splanchnic …
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Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation
Circulation, 2003Co-Authors: Athar M. Qureshi, Lourdes R Prieto, Larry A Latson, Richard D. White, Geoffrey K. Lane, C.igor Mesia, Penelope A. Radvansky, Nassir F. Marrouche, Eduardo B. Saad, Dianna BashAbstract:Background— Pulmonary Vein Stenosis has recently been recognized as a complication of radiofrequency ablation for atrial fibrillation. This study evaluates the presentation of affected patients and...
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Pulmonary Vein Stenosis after catheter ablation of atrial fibrillation emergence of a new clinical syndrome
Annals of Internal Medicine, 2003Co-Authors: Eduardo B. Saad, Lourdes R Prieto, Richard D. White, Nassir F. Marrouche, Dianna Bash, Cynthia P Saad, Edward Ha, John F Rhodes, David O Martin, Walid I SalibaAbstract:BACKGROUND: Pulmonary Vein isolation is a new, effective curative procedure for selected patients with atrial fibrillation. Pulmonary Vein Stenosis is a potential complication and may lead to symptoms that are often underrecognized. OBJECTIVE: To describe the clinical course and symptoms associated with Pulmonary Vein Stenosis developing after ablation in the Pulmonary Veins. DESIGN: Retrospective study. SETTING: Tertiary care referral center. PATIENTS: 335 patients referred for catheter ablation of drug-refractory atrial fibrillation. INTERVENTION: Pulmonary Vein electrical isolation using radiofrequency catheter ablation. MEASUREMENTS: Three months after ablation, patients underwent routine screening for Pulmonary Vein Stenosis with spiral computed tomography. Screening was considered earlier if symptoms suggestive of Stenosis developed and was repeated at 6 and 12 months if any Pulmonary Vein narrowing was observed. Pulmonary Vein angiography and dilatation were offered to patients with severe (>70%) Stenosis. RESULTS: Severe Pulmonary Vein Stenosis was detected in 18 patients (5% [95% CI, 3.2% to 8.4%]) a mean (+/-SD) of 5.2 +/- 2.6 months after ablation. Eight of these 18 patients (44%) were asymptomatic, but 8 (44%) reported shortness of breath, 7 (39%) reported cough, and 5 (28%) reported hemoptysis. Radiologic abnormalities were present in 9 patients (50%) and led to diagnoses of pneumonia (4 patients), lung cancer (1 patient), and Pulmonary embolism (2 patients). Pulmonary Vein Stenosis was not considered in any patient during the initial work-up. Dilatation of the affected Vein was performed in 12 patients. Postintervention lung perfusion scans revealed significant improvement in lung flow. CONCLUSIONS: Severe Pulmonary Vein Stenosis after catheter ablation of atrial fibrillation is associated with respiratory symptoms that frequently mimic more common diseases, often leading to erroneous diagnostic and therapeutic procedures. Awareness of this syndrome is important for proper and prompt management.
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Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: Emergence of a New Clinical Syndrome
Annals of Internal Medicine, 2003Co-Authors: Eduardo B. Saad, Lourdes R Prieto, Richard D. White, Nassir F. Marrouche, Dianna Bash, Cynthia P Saad, John F Rhodes, David O Martin, Walid I SalibaAbstract:Severe Pulmonary Vein Stenosis after catheter ablation of atrial fibrillation is associated with respiratory symptoms that often mimic more common diseases.
Erin A. Fender - One of the best experts on this subject based on the ideXlab platform.
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severe Pulmonary Vein Stenosis resulting from ablation for atrial fibrillation
Circulation, 2016Co-Authors: Erin A. Fender, Kristi H. Monahan, David R. Holmes, Jay R Widmer, David O Hodge, George M Cooper, Laurie A Peterson, Douglas L. PackerAbstract:Background:The frequency of Pulmonary Vein Stenosis (PVS) after ablation for atrial fibrillation has decreased, but it remains a highly morbid condition. Although treatment strategies including pul...
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Pulmonary Vein Stenosis after atrial fibrillation ablation.
EuroIntervention, 2016Co-Authors: Erin A. Fender, Douglas L. Packer, David R. HolmesAbstract:Pulmonary Vein Stenosis (PVS) is an uncommon but devastating complication of atrial fibrillation (AF) ablation. Patients are often misdiagnosed due to non-specific symptoms and the challenges of visualising the Pulmonary Veins on standard chest imaging. Delays in treatment result in worsening symptoms and Pulmonary venous occlusion. The optimal method of intervening for PVS has not been well established. ReStenosis after successful intervention is common, warrants active surveillance, and is the focus of research into prevention and management strategies. In this article we review the existing literature on PVS, and discuss our own experience in managing patients with severe PVS.
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TCT-739 Management of Recurrent Pulmonary Vein Stenosis
Journal of the American College of Cardiology, 2015Co-Authors: Erin A. Fender, R. Jay Widmer, Kristi H. Monahan, Laura A. Peterson, David R. Holmes, Douglas L. PackerAbstract:One to five percent of AF ablations may be complicated by Pulmonary Vein Stenosis (PVS). Initial management of high grade Stenosis is performed with balloon angioplasty or stents. ReStenosis occurs frequently. We sought to assess our center's outcomes in patients with reStenosis following an
