Thomas P. Doyle, James E. Loyd, Ivan M. Robbins
Vanderbilt University School of Medicine.
United States
American Journal of Respiratory and Critical Care Medicine
Am J Repir Crit Care Med 2001; 164: 657-660
DOI: 10.1164/ajrccm.164.4.2012132
Abstract
Mediastinal fibrosis is a rare consequence of infection with the fungus Histoplasma capsulatum that can lead to occlusion of large pulmonary arteries and veins and mainstem bronchi. Medical and surgical treatments for this disorder have been ineffective. We describe successful treatment for central pulmonary arterial and venous obstruction due to mediastinal fibrosis in four patients using percutaneously placed intravascular stents. Patients were severely limited, World Health Organization functional class III or IV. At the time of right and left heart catheterization, stents were placed in pulmonary arteries (n = 1), veins (n = 2), or both (n = 1) to relieve vascular obstruction resulting from mediastinal fibrosis. Immediate hemodynamic and clinical improvement was observed in all patients. Three of the four patients have had sustained improvement in exercise tolerance, from 3.5 mo to 4.5 yr after stent placement. The only complication was a self-limited pulmonary hemorrhage in one patient. Our initial experience suggests that percutaneous stent placement to relieve central pulmonary arterial or venous obstruction due to mediastinal fibrosis is an effective new treatment modality.
Category
Stenosis or Obstruction of Normal Pulmonary Venous Connections
Catheter-mediated Interventions: Efficacy or Lack of Efficacy
Catheter-mediated Interventions: Adverse Effects or Lack of Adverse Effects
Year of Publication: 2001
Age Focus: Adult
Article Type: Case Reports or Retrospective Observations in Small Groups of Patients (≤10 patients)
Article Access: Free PDF File or Full Text Article Available Through PubMed or DOI: No