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Percutaneous pulmonary artery and vein stenting: a novel treatment for mediastinal fibrosis.

Doyle TP, Loyd JE, Robbins IM
Am J Respir Crit Care Med. 2001 164 (4): 657-60

PMID: 11520733 · DOI:10.1164/ajrccm.164.4.2012132

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.

MeSH Terms (20)

Adult Angiography Cardiac Catheterization Constriction, Pathologic Exercise Test Female Fibrosis Follow-Up Studies Histoplasmosis Humans Male Mediastinal Diseases Mediastinum Middle Aged Phlebography Pulmonary Artery Pulmonary Veins Severity of Illness Index Stents Treatment Outcome

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