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 8282. 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. 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 presence of a fixed lesion, despite high inflation pressures of a non-compliant angioplasty balloon, a cutting balloon might be considered. Where there is significant recoil of a lesion and the clinical circumstances demand a good result,...