Predicting Outcomes in Pediatric Intraluminal Pulmonary Vein Stenosis Using a Comprehensive Standardized Catheterization Assessment: A Prospective Study.

BACKGROUND

Pediatric intraluminal pulmonary vein stenosis (PVS) occurs in a heterogeneous patient population but is unified by its cellular composition in affected pulmonary veins. Enhanced delineation of the hemodynamic and physiological vein consequences of PVS and its impact on vein lumen, vein pressure, wall structure, vein compliance, and wall shear stress has not been studied. The objective is to assess PVS characteristics using multimodal catheterization techniques (angiography, pulmonary vein pressure, intravascular ultrasound, balloon compliance testing, and wall shear stress calculation) and determine their association with vein outcomes.

METHODS

The study is a prospective trial applying a standardized catheterization assessment to patients under 13 years of age who are undergoing cardiac catheterization for PVS. The primary outcome is vein status at 12 months, assigned by an end point committee. The secondary outcome is transplant-free survival.

RESULTS

Overall, 50 patients with a median age of 2.7 years (range, 0.3-11.8) underwent assessment and included angiography of 200 veins, 171 pressure assessment, 169 intravascular ultrasound, 58 balloon compliance testing, and 141 wall shear stress calculations. The probability of a worse vein outcome increased as angiographic severity score, percent wall thickness by intravascular ultrasound, postintervention gradient, or postintervention wall shear stress increased. Multivariable analysis demonstrated veins with angiographic upstream luminal narrowing (odds ratio, 3.26 [95% CI, 1.38-7.7]; P=0.007), ostial diameter <6 mm (odds ratio, 3.93 [95% CI, 1.29-12]; P=0.016), and ≥35% upstream wall thickness by intravascular ultrasound (odds ratio, 5.05 [95% CI, 2.03-12.5]; P<0.001) are associated with a worse vein outcome. A 3-point Invasive Pulmonary Vein Score prediction tool was created. Transplant-free survival was 92% at 12 months.

CONCLUSIONS

A multimodal pulmonary vein catheterization assessment determined angiographic and intravascular ultrasound findings to be the most predictive of 12-month pulmonary vein outcome.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04696289.