Pulmonary vein stenosis with collateralization via esophageal varices: Long-term follow-up after successful treatment with drug-eluting stent

• Published in: Congenital heart disease Vol. 13; no. 1; p. 124
• Main Authors: Goldberg, Jason F, Jensen, Craig L, Krishnamurthy, Rajesh, Varghese, Nidhy P, Justino, Henri
• Format: Journal Article
• Language: English
• Published: United States 01.01.2018
• Subjects: Angioplasty, Balloon - methods; Antineoplastic Agents, Phytogenic - pharmacology; Child; Child, Preschool; Coated Materials, Biocompatible; Collateral Circulation; Coronary Angiography; Drug-Eluting Stents; Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Humans; Infant; Male; Paclitaxel - pharmacology; Polytetrafluoroethylene; Stenosis, Pulmonary Vein - complications; Stenosis, Pulmonary Vein - diagnosis; Stenosis, Pulmonary Vein - surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; esophageal varives; drug eluting stent; pulmonary vein stenosis; pulmonary hypertension
• ISSN: 1747-0803
• DOI: 10.1111/chd.12537

We describe the long-term follow-up of a child with recurrent hemoptysis due to severe pulmonary vein stenosis decompressing via collaterals to esophageal varices. Case report SETTING: Tertiary children's hospital PATIENT: Single child through ages 2- to 11-year old INTERVENTIONS: The child underwent cutting balloon angioplasty, bare metal stenting, and implantation of a PTFE-covered stent, all of which failed rapidly. Only after placement of a paclitaxel drug eluting stent did he have prolonged relief from hemoptysis and long-term patency of the treated vein. The stents were serially dilated to keep up with somatic growth of the child, eventually culminating in the need to induce intentional stent fracture. We highlight novel transcatheter techniques to treat this vexing condition, discuss mechanisms of disease treatment and progression, and present the only patient with this rare combination of lesions to have achieved both longstanding pulmonary vein patency and resolution of esophageal varices.