scholarly journals The impact of right ventricular pressure and function on survival in patients with pulmonary vein stenosis

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401877689 ◽  
Author(s):  
Michelle C. Sykes ◽  
Christina Ireland ◽  
Julia E. McSweeney ◽  
Emily Rosenholm ◽  
Kristofer G. Andren ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pulmonary Vein ◽  
Cardiac Catheterization ◽  
Systolic Function ◽  
Balloon Dilation ◽  
Pulmonary Vein Stenosis ◽  
Pulmonary Hemodynamics ◽  
Vein Stenosis ◽  
The Impact ◽  
Rv Function

Pulmonary vein stenosis (PVS) is associated with pulmonary hypertension (PH), but there is little information regarding the impact of PH on right ventricular (RV) systolic function and survival. We conducted a retrospective cohort study of our patients to explore this and other aspects of pulmonary hemodynamics with PVS. RV function was assessed using qualitative two-dimensional echocardiography. The ratio of systolic pulmonary artery (PA) and aortic pressures (PA:Ao) at cardiac catheterization reflected pulmonary hemodynamics. Reactivity testing employed inhaled nitric oxide + 100% fiO2, or 100% fiO2 only; “reactivity” was a ≥ 20% decrease in PA:Ao. There were 105 PVS patients, although not all had data at every time point. (1) The mean PA:Ao at first cardiac catheterization (n = 77) was 0.79 ± 0.36; at last catheterization (n = 54), PA:Ao = 0.69 ± 0.30; 90% had systolic PAP > one-half systemic. Survival was shorter with PA:Ao > 0.5. (2) Differences in survival relative to RV dysfunction on the first echocardiogram were not significant, although they were using the last echocardiogram. (3) The magnitude of RV dysfunction was positively correlated with PA:Ao. (4) Balloon dilation of PV acutely decreased PA:Ao (–0.13 ± 0.37, P = 0.03 [n = 40 patients]). 5. Of 20 patients tested, 13 were acutely reactive to vasodilators. PH is a major feature of PVS. Reduced RV function and PA:Ao appear to be predictors of survival. Given the importance of PH in this disease, clinical studies of PVS treatments should include measures of PAP and RV function as important variables of interest.

scholarly journals Pulmonary Vein Stenosis: Case Report and Literature Review

2009 ◽  
Vol 16 (6) ◽  
pp. e77-e80 ◽  
Author(s):  
R Amin ◽  
S Kwon ◽  
Y Moayedi ◽  
N Sweezey
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Systolic Pressure ◽  
Pulmonary Vein Stenosis ◽  
Ventricular Systolic Pressure ◽  
The Family ◽  
Transient Improvement ◽  
Vein Stenosis

BACKGROUND: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, with variable onset and presentation. One or more of the four pulmonary veins can be primarily or secondarily affected. A five-month-old girl presented with respiratory distress, lethargy and cyanosis requiring intubation.METHODS: Echocardiography showed right ventricular dilation, a right ventricular systolic pressure of 97 mmHg, decreased ejection fraction and turbulent flow at the left atrium. Cardiac catheterization revealed stenosis of the left-sided pulmonary veins, for which she underwent a Coles procedure.RESULTS: Postoperatively, there was a transient improvement in the patient’s pulmonary hypertension but she subsequently deteriorated. Her prognosis was considered bleak, and a decision was made with the family to withdraw care.CONCLUSION: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, and is associated with significant morbidity and mortality. Surgical intervention may be of benefit in selected cases. It stands to reason that any treatment will have the best chance of success if completed before the pulmonary hypertension becomes fixed. Early diagnosis depends on a high index of clinical suspicion.

Abstract 15719: Right Ventricular Dysfunction After Transcatheter Aortic Valve Replacement (TAVR)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Saki Ito ◽  
Sorin V Pislaru ◽  
Vuyisile T Nkomo ◽  
Jae K Oh ◽  
Kevin L Greason ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Aortic Valve Area ◽  
Transcatheter Aortic Valve ◽  
The Impact ◽  
Rv Function

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients at high surgical risk. We investigated the impact of TAVR on left (LV) and right ventricular (RV) function using conventional echocardiography parameters. Methods and results: A total of 202 consecutive patients (age 80.6±8.0 years, aortic valve area 0.80±0.16cm 2 ) who underwent TAVR at Mayo Clinic between 2008 and 2013 were included in the study. LV ejection fraction (EF) and RV systolic function including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and, systolic excursion velocity (S’) were compared before (median 33.5 days) and after TAVR procedure (median 30 days). Patients who underwent pacemaker implantation after TAVR were excluded. LV EF significantly improved following TAVR (55.3±12.6% pre vs 58.5±11.1% post; p<0.05). In contrast, RV systolic function significantly decreased after TAVR (pre vs post; TAPSE: 18.8±6.3 mm vs 17.4±6.3 mm, FAC: 42.6±9.8% vs 37.3±8.2%; S’: 10.7±2.6 cm/s vs 10.2±2.6 cm/s; p<0.05 for all). Stratifying RV functional change by TAVR approach site, patients undergoing trans-femoral TAVR (n=100) showed RV deterioration only by FAC (see Table). In contrast, RV systolic dysfunction was more prominent in trans-apical approach group (n=87) with significant decline in all parameters of RV systolic function (see Table). Conclusion: TAVR is associated with early enhancement in LV systolic function. However, there is evidence of worsening RV function in a significant number of patients. Further studies are necessary to determine whether this deterioration in RV function is related to anatomic access site or to other factors, and to evaluate its prognostic significance.

scholarly journals The Role of Elevated Wall Shear Stress in Progression of Pulmonary Vein Stenosis: Evidence from Two Case Studies

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 729
Author(s):  
Peter E. Hammer ◽  
Kerry McEnaney ◽  
Ryan Callahan ◽  
Christopher W. Baird ◽  
David M. Hoganson ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Disease Progression ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Balloon Dilation ◽  
Pulmonary Vein Stenosis ◽  
Multiple Time ◽  
Wall Shear ◽  
Vein Stenosis

Pulmonary vein stenosis is a serious condition characterized by restriction or blockage due to fibrotic tissue ingrowth that develops in the pulmonary veins of infants or children. It is often progressive and can lead to severe pulmonary hypertension and death. Efforts to halt or reverse disease progression include surgery and catheter-based balloon dilation and stent implantation. Its cause and mechanism of progression are unknown. In this pilot study, we propose and explore the hypothesis that elevated wall shear stress at discrete pulmonary venous sites triggers stenosis. To assess this theory, we retrospectively analyzed cardiac catheterization, lung scan, and X-ray computed tomography data to estimate wall shear stress in the pulmonary veins at multiple time points during disease progression in two patients. Results are consistent with the existence of a level of elevated wall shear stress above which the disease is progressive and below which progression is halted. The analysis also suggests the possibility of predicting the target lumen size necessary in a given vein to reduce wall shear stress to normal levels and remove the trigger for stenosis progression.

scholarly journals Primary pulmonary vein stenosis: The impact of sutureless repair on survival

2011 ◽  
Vol 142 (2) ◽  
pp. 344-350 ◽  
Author(s):  
Nicola Viola ◽  
Abdullah A. Alghamdi ◽  
Donald G. Perrin ◽  
Gregory J. Wilson ◽  
John G. Coles ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Stenosis ◽  
Sutureless Repair ◽  
Vein Stenosis ◽  
The Impact
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