Percutaneous pulmonary artery and vein stenting - A novel treatment for mediastinal fibrosis

Mediastinal fibrosis is a rare consequence of infection with the fungus His toplasma capsulatum that can lead to occlusion of large pulmonary arteries and veins and mainstem bronchi. Medical and surgical treatments for this di sorder have been ineffective. We describe successful treatment for central pulmonary arterial and venous obstruction due to mediastinal fibrosis in fo ur 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 pu lmonary arteries (n = 1), veins (n = 2), or both (n = 1) to relieve vascula r obstruction resulting from mediastinal fibrosis. Immediate hemodynamic an d clinical improvement was observed in all patients. Three of the four pati ents 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 pulmo nary hemorrhage in one patient. Our initial experience suggests that percut aneous stent placement to relieve central pulmonary arterial or venous obst ruction due to mediastinal fibrosis is an effective new treatment modality.