O'Halloran Conor P, Hauck Amanda, Fox Jeremy, Laternser Christina, Hoyt Emily, Nugent Alan W, Tannous Paul
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Catheter Cardiovasc Interv. 2025 Sep;106(3):1732-1739. doi: 10.1002/ccd.31737. Epub 2025 Jul 3.
Endovascular stent placement for pulmonary vein stenosis (PVS) provides effective obstruction relief. Due to small patient size and limited length options of available stents, pulmonary vein branches can be covered ("jailed") during stenting. The natural history of jailed veins, and whether side cell dilation (SCD) modifies this natural history, is unknown.
Pulmonary vein stents placed January 2017 to May 2024 at a single center were reviewed to determine if any veins were jailed during stent deployment. Jailed vein diameter was measured before stent placement. Subsequent SCD, and jailed vein patency at the most recent catheterization are reported. The relationship between jailed vein survival and SCD was evaluated by log rank test using SCD as a time varying covariate to account for patients who have delayed SCD.
Eighty-one stents were placed in 42 patients at a median of 9.1 months of age and 7.0 kg. 45 stents (56%) jailed at least one pulmonary vein branch. Excluding five stents without follow-up, 51 jailed veins were identified as the result of 40 stents placed in 20 patients. Immediate SCD was performed in 11 jailed veins (22%) and 24 additional jailed veins received SCD at a subsequent procedure, thus 35 jailed branches (69%) received SCD. With a median follow-up of 1.1 years, 35 jailed branches (69%) remained patent. The estimated jailed vein patency at 9 months for veins not receiving SCD was 70% (95% CI: 44%-86%) compared to 97% (95% CI: 79%-99%) for jailed veins that did receive SCD (log rank p = 0.005).
Jailing of pulmonary veins was common during stent placement for PVS in children. Without SCD, jailed vein patency is low. Jailed vein patency was significantly improved with SCD.
血管内支架置入术治疗肺静脉狭窄（PVS）可有效缓解梗阻。由于患者体型小且可用支架的长度选择有限，在支架置入过程中肺静脉分支可能会被覆盖（“被困”）。被困静脉的自然病程以及侧支细胞扩张（SCD）是否会改变这种自然病程尚不清楚。
回顾2017年1月至2024年5月在单一中心置入的肺静脉支架，以确定在支架置入过程中是否有静脉被困。在支架置入前测量被困静脉直径。报告随后的SCD以及最近一次导管检查时被困静脉的通畅情况。以SCD作为随时间变化的协变量，采用对数秩检验评估被困静脉存活与SCD之间的关系，以考虑SCD延迟的患者。
42例患者共置入81枚支架，中位年龄9.1个月，体重7.0 kg。45枚支架（56%）困住了至少一个肺静脉分支。排除5枚无随访的支架后，20例患者置入的40枚支架导致51条被困静脉被识别。11条被困静脉（22%）立即进行了SCD，另外24条被困静脉在后续手术中接受了SCD，因此35条被困分支（69%）接受了SCD。中位随访1.1年，35条被困分支（69%）保持通畅。未接受SCD的静脉在9个月时的预计通畅率为70%（95%CI：44%-86%），而接受SCD的被困静脉为97%（95%CI：79%-99%）（对数秩p = 0.005）。
在儿童PVS支架置入过程中，肺静脉被困很常见。若无SCD，被困静脉通畅率低。SCD可显著提高被困静脉通畅率。
