Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
Catheter Cardiovasc Interv. 2010 Jun 1;75(7):1084-90. doi: 10.1002/ccd.22405.
Pulmonary vein stenosis (PVS) is a rare and often lethal condition in children. The optimal treatment for congenital and postoperative PVS is unknown.
We compared outcomes of conventional balloon angioplasty performed for PVS from 1999 to 2003 against cutting balloon angioplasty performed from 2004 to 2007. A total of 100 previously undilated pulmonary veins in 54 patients were studied: 48 veins dilated with conventional balloons and 52 with cutting balloons. Acute results included significantly reduced gradients and increased lumen diameters with both treatments. Acutely, cutting balloon angioplasty and conventional angioplasty yielded similar relative reduction of the PVS gradient (median 78% vs. 63%, P = 0.08) and increase in lumen diameter (median 77% vs. 59%, P = 0.07). There was one procedural death of a critically ill infant, and four cardiac arrests, but no adverse events necessitating surgical intervention. Survival free from reintervention was poor in both groups, and shorter in the cutting balloon group (73% at 1 month, 11% at 6 months, and 4% at 1 year) than in the conventional angioplasty group (77% at 1 month, 35% at 6 months, and 23% at 1 year; P = 0.01).
Both conventional and cutting balloon angioplasty were effective at decreasing gradient and increasing lumen size acutely in patients with congenital and postoperative PVS, but reintervention was common with both treatments. Both methods of angioplasty provided limited benefit, and neither was curative for this complex disease.
肺静脉狭窄（PVS）是儿童中一种罕见且常常致命的病症。先天性和术后 PVS 的最佳治疗方法尚不清楚。
我们比较了 1999 年至 2003 年期间进行的传统球囊血管成形术与 2004 年至 2007 年期间进行的切割球囊血管成形术治疗 PVS 的结果。共有 54 例患者的 100 条未扩张肺静脉接受了研究：48 条静脉采用传统球囊扩张，52 条采用切割球囊扩张。急性结果包括两种治疗方法均可显著降低狭窄程度和增加管腔直径。在急性情况下，切割球囊血管成形术和传统血管成形术对 PVS 狭窄梯度的相对降低程度相似（中位数分别为 78%和 63%，P = 0.08），管腔直径的增加程度也相似（中位数分别为 77%和 59%，P = 0.07）。有一名危重病婴儿在手术过程中死亡，有 4 例心脏骤停，但没有需要手术干预的不良事件。两组患者的无再介入生存率均较差，且切割球囊组更差（1 个月时为 73%，6 个月时为 11%，1 年时为 4%），低于传统球囊组（1 个月时为 77%，6 个月时为 35%，1 年时为 23%；P = 0.01）。
在先天性和术后 PVS 患者中，传统球囊和切割球囊血管成形术在急性时均能有效降低狭窄程度并增加管腔直径，但两种治疗方法都需要进行再次介入。两种血管成形术方法均提供了有限的益处，都不能治愈这种复杂疾病。
