Interventions for congenital and acquired pulmonary vein stenosis

Summary

PVS is a progressive illness and unless good surgical relief can be obtained early in the course of the disease the course becomes recalcitrant to further therapeutic intervention with long-term results being generally disappointing. Published series do, however, clearly document short-term improvements from catheter approaches, not only in terms of vessel diameter, pullback gradients and right ventricular pressure or pulmonary artery resistance, but also in patient symptoms. There is clearly much room for improvement in the management of this condition though the rarity of the lesion precludes significant advances from being made. Animal models hold some promise 82, 8382. Mutsuga M, Narita Y, Yamawaki A, Satake M, Kaneko H, Usui A, Ueda Y. Development of novel drug-eluting biodegradable nano-fiber for prevention of postoperative pulmonary venous obstruction. Interact Cardiovasc Thorac Surg. 2009;8:402-6; discussion 6-7. Link83. Furukawa T, Kishiro M, Fukunaga H, Ohtsuki M, Takahashi K, Akimoto K, Shimizu T, Kawasaki S, Kumasaka T. Drug-eluting stents ameliorate pulmonary vein stenotic changes in pigs in vivo. Pediatr Cardiol. 2010;31:773-9. Link. A reasoned interventional approach following exploration of surgical options and a joint institution decision would begin with a careful diagnostic catheter study followed by targeted angioplasty. In the...