Catheter based interventions to treat pulmonary vein stenosis
Catheter based studies are used frequently in diagnosing and treating pulmonary vein stenosis.
To do this procedure, the doctor will put a thin wire or tube called a catheter into a vein or artery in your child's neck or leg area. The catheter can then be guided using the vein or artery into the heart. When the catheter is in the heart, it can be used to look at the pulmonary veins and treat pulmonary vein stenosis.
The doctor who does the procedure is a cardiologist (a doctor who specializes in heart and blood vessels). They will be part of the team that is caring for your child. The procedure is performed while your child is under a general anaesthetic. This means that your child will be asleep during the procedure.
To do this procedure, the doctor will put a thin wire or tube called a catheter into a vein or artery in your child's neck or leg area. The catheter can then be guided using the vein or artery into the heart. When the catheter is in the heart, it can be used to look at the pulmonary veins and treat pulmonary vein stenosis.
The doctor who does the procedure is a cardiologist (a doctor who specializes in heart and blood vessels). They will be part of the team that is caring for your child. The procedure is performed while your child is under a general anaesthetic. This means that your child will be asleep during the procedure.
What is the difference between a diagnostic catheter study, a balloon dilatation and stenting?
A diagnostic catheter study is when the team wants to understand the anatomy and the severity of the pulmonary vein stenosis. When the catheter is in the heart, they will inject a dye that will help to visualize the pulmonary veins.
In addition, they will use a special catheter that allows them to measure the pressures in the pulmonary veins and arteries, the right heart and other structures in the heart. This gives the doctors important information about how severe the disease is and how the right heart is functioning.
In addition, they will use a special catheter that allows them to measure the pressures in the pulmonary veins and arteries, the right heart and other structures in the heart. This gives the doctors important information about how severe the disease is and how the right heart is functioning.
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The diagnostic study can be combined with a procedure on the pulmonary veins. The procedure typically is either balloon angioplasty or stent placement.
Balloon angioplasty is when the doctors use special catheters with a small balloon and dilate open the area of stenosis. The area of stenosis will open up and allow blood to drain. There are newer balloons now that are coated with drugs that stop proliferation in the local area. Sometimes the interventionalist will choose to place a stent in the area of stenosis. This is when a small stent is placed in the area of stenosis and expanded. The stent helps to keep the vein open and adds support to the walls of the vein. |
Who gets catheter based interventions?
Not all veins with pulmonary vein stenosis can have catheter based interventions. Sometimes the stenosis involves too much of the vein or it is too narrowed to put place a catheter through. Sometimes if there are too many branches in the pulmonary vein, a stent can not be placed. Sometimes the stenosis is better treated with balloon angioplasty or surgery to repair the veins.
Catheter based interventions typically required repeated interventions. Therefore, your child may require multiple balloon dilations to keep the veins open.
Catheter based interventions typically required repeated interventions. Therefore, your child may require multiple balloon dilations to keep the veins open.
What type of stents can be used to treat pulmonary vein stenosis?
The are different types of stents that can be used to treat pulmonary vein stenosis; however little is known about which stents work best. Most of the literature on stents is from coronary artery stenting, which is not the same as pulmonary veins. Studies that looked at the success of stents in children with pulmonary vein stenosis suggest that the bigger the stent that is put in the better chance one has to not develop in stent restenosis. However, the rate of needing another procedure is still high following stenting.
Bare metal stents: These stents are like a wire cage that is used to open up the area with stenosis. They were the first type of stent used and have good results.
Drug eluting stents: These are a newer type of stent that has drug that targets proliferating cells. When a stent is put in place, the tissues of the vein are crushed and it sets up a local proliferative reaction. The drugs in the stents are used to slow or arrest the proliferative reaction to prevent in-stent restenosis.
Bioabsorbable stents: These are the newest type of stent available. The stent part reabsorbs after 6-12 months and usually they are coated with a drug that targets proliferation. There is no data about this stent in children with PVS.
Bare metal stents: These stents are like a wire cage that is used to open up the area with stenosis. They were the first type of stent used and have good results.
Drug eluting stents: These are a newer type of stent that has drug that targets proliferating cells. When a stent is put in place, the tissues of the vein are crushed and it sets up a local proliferative reaction. The drugs in the stents are used to slow or arrest the proliferative reaction to prevent in-stent restenosis.
Bioabsorbable stents: These are the newest type of stent available. The stent part reabsorbs after 6-12 months and usually they are coated with a drug that targets proliferation. There is no data about this stent in children with PVS.
What are the risks with catheter based interventions?
Catheter based interventions are associated with risks as they are invasive procedures. One of the main risks is that sometimes the veins can get holes in them when the balloons are dilated. This can cause a bleed in the lung tissue. Talk to your cardiologists about the risks associated with these procedures.