Trancatheter isolation of ipsilateral branch pulmonary artery to treat unilateral pulmonary vein occlusion: a novel technique and mid to long-term outcomes

Background:
Pulmonary vein occlusion (PVO) is associated with poor outcomes, particularly when additional cardiac defects or single ventricle anatomy are present.

Methods:
We analyzed the outcomes of all patients who underwent intentional transcatheter isolation of the ipsilateral branch pulmonary artery (BPA) to treat unilateral PVO. Patients who underwent this procedure from 2003-2018 were identified. Patient profile and medium to long-term follow up were reviewed.

Results:
Seven patients were identified who underwent intentional transcatheter isolation of a BPA with an occluder device. All patients had unilaterally occluded pulmonary veins, (5 left and 2 right). Three patients had single ventricle anatomy (Glenn = 1; Fontan = 2); 4 had biventricular circulation. Indications for the single ventricle patients were significant aortopulmonary collaterals with reversal of blood flow in the BPA on the side of the occluded pulmonary vein. Of the patients with biventricular circulation, indications included pulmonary hemorrhage. The procedure was successful in all patients. All patients survived to hospital discharge. Of the single ventricle patients, all were being evaluated for transplant at most recent visit. 2 of the 3 single ventricle patients were ultimately lost to follow up, though they were alive at 4 months and 10 years post-procedure. Those who presented with pulmonary hemorrhage as an indication for intervention all resolved post-procedure. Per most recent clinic visit (mean follow up of ~4 years), all patients were alive.

Conclusions:
In patients with unilateral PVO resulting in reversal of flow in an ipsilateral BPA or pulmonary hemorrhage, device occlusion of the ipsilateral BPA may offer a palliative benefit.