[Short-term efficacy and perioperative safety of catheter-based intervention for pulmonary vein stenosis caused by fibrosing mediastinitis].

Objective: To evaluate the short-term efficacy and perioperative safety of catheter-based intervention in patients with pulmonary vein stenosis caused by fibrosing mediastinitis (FM). Methods: It was a case series study. Consecutive patients with pulmonary vein stenosis caused by FM, who underwent percutaneous pulmonary vein angioplasty in Gansu Provincial Hospital from January 2018 to June 2020, were retrospective enrolled. The baseline characteristics, comorbidities, exercise capacity and hemodynamic data before and after treatment were compared, and the procedural related complications were evaluated. Results: A total of 30 patients ((64.3±7.1) years, 15 males) were included. Sixty-three pulmonary vein stenosis were treated by 32 percutaneous pulmonary vein angioplasty procedures. Forty-four stents were implanted in 41 pulmonary veins after balloon angioplasty, and the diameter of implanted stents was (8.3±1.2)mm. Balloon angioplasty was performed on 22 pulmonary vein stenosis, the mean balloon diameter was (4.2±2.1)mm. The pulmonary vein diameter increased from (2.6±1.3) to (6.6±2.6) mm (P<0.001) and the pressure gradient across the pulmonary vein stenotic segment reduced from 19 (12, 29) to 2 (0, 4) mmHg (1 mmHg=0.133 kPa) (P<0.001) immediately post procedure. The pulmonary vein flow grade was significantly improved compared with baseline (P<0.001). The most common operation related complications were lung injury (44.0% (11/25)) and hemoptysis (18.8% (6/32)), which did not need special treatment. During the 2.0 (1.3, 3.2) months follow-up, the WHO functional class was significantly improved (P<0.05), the 6-minute walking distance increased from (254.8±114.5) m to (342.8±72.4)m (P<0.05), the mean pulmonary arterial pressure decreased from (40.9±8.3) mmHg to (35.4±7.7) mmHg (P<0.01), 17 out of 19 patients with refractory pleural effusion experienced total remission during the follow-up period (P<0.001). CT pulmonary venography was repeated in 17 patients. The incidence of in-stent restenosis of pulmonary vein was 24.0% (6/25). Conclusions: Percutaneous pulmonary vein angioplasty is effective for the treatment of pulmonary vein stenosis caused by fibrosing mediastinitis. However, it's not so safe, procedural related complication should be paid attention to and the rate of in-stent restenosis is relative high during the short-term follow-up.目的： 探讨经皮肺静脉成形术治疗纤维纵隔炎所致肺静脉狭窄的短期疗效与安全性。 方法： 该研究为病例系列研究。回顾性纳入2018年1月至2020年6月在甘肃省人民医院诊断为纤维纵隔炎所致肺静脉狭窄并接受经皮肺静脉成形术治疗的患者。通过电子病历系统收集患者的临床资料，包括年龄、性别、合并症，术前右心导管测得的血流动力学指标、N末端B型利钠肽原（NT-proBNP）水平、6 min步行距离、动脉血氧饱和度（SaO2）、世界卫生组织（WHO）功能分级，干预血管术前及术后直径、跨狭窄压差和支架大小，随访期间上述右心导管测得的血流动力学指标、NT-proBNP水平、6 min步行距离、SaO2、WHO功能分级，无法门诊或住院随访的患者通过电话联系获得患者主观报告的临床改善情况并评估WHO功能分级。 结果： 研究最终纳入患者30例，年龄（64.3±7.1）岁，男性15例（50.0%）。进行了32台次经皮肺静脉成形术，干预狭窄肺静脉63支，41支肺静脉经球囊扩张后行支架置入术，置入支架44枚，支架直径（8.3±1.2）mm；22支肺静脉行单纯球囊成形术，球囊直径（4.2±2.1）mm。肺静脉最窄段直径从术前的（2.6±1.3）mm增加至术后的（6.6±2.6）mm（P<0.001），跨狭窄压差由术前的19（12，29）mmHg（1 mmHg=0.133 kPa）下降至术后的2（0，4）mmHg（P<0.001），术后肺静脉血流分级较术前明显改善（P<0.001）。最常见的手术相关并发症为肺损伤［44.0%（11/25）］和咯血［18.8%（6/32）］，均无需特殊处理。术后随访2.0（1.3，3.2）个月，WHO功能分级明显改善（P<0.05），6 min步行距离由（254.8±114.5）m增加至（342.8±72.4）m（P<0.05），平均肺动脉压由（40.9±8.3）mmHg下降至（35.4±7.7）mmHg（P<0.01）。17例患者术后随访复查了CT肺静脉造影，示支架内再狭窄发生率为24.0%（6/25）。 结论： 经皮肺静脉成形术治疗纤维纵隔炎所致肺静脉狭窄短期疗效尚可，但存在一定风险，而且支架内再狭窄率高。.