Related Experiment Video
Updated: Apr 19, 2026
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis
Daiji Takajo1,2,3, Paul J Critser4,5, Awais Ashfaq4,5
1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. dt1449@gmail.com.
Insights
Pulmonary vein stenosis (PVS) treatment in children is complex. While surgery is an option for severe cases, reintervention is common, highlighting the need for tailored strategies in pediatric PVS management.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary vein stenosis (PVS) is a rare but serious pediatric condition.
- Optimal initial treatment strategy for PVS is unclear due to complexity and recurrence.
- Interventions like surgery or catheterization are often required.
Purpose of the Study:
- To compare outcomes of catheter-based intervention versus surgical repair in children with PVS.
- To identify factors influencing treatment choice and outcomes in pediatric PVS.
- To evaluate reintervention rates and mortality in different PVS treatment groups.
Main Methods:
- Retrospective, single-center study of children with PVS (2015-2023).
- Exclusion of patients with single ventricle physiology.
- Comparison of outcomes between catheter-based intervention only and surgical repair groups (with or without reintervention).
Main Results:
- 56 children with biventricular physiology and PVS were analyzed.
- Surgical repair was performed in 29% of cases, often for complex or bilateral disease.
- Catheter-based interventions became more preferred over time; 92% of surgical patients required reintervention.
- Mortality did not significantly differ between groups, but elevated RV/SVP ratio and scimitar syndrome increased mortality in the surgical group.
Conclusions:
- Surgical pulmonary vein repair is a viable option for complex PVS cases unsuitable for catheterization.
- Recurrent pulmonary vein re-intervention is frequent, irrespective of the initial treatment approach.
- Careful patient selection and management strategies are crucial for pediatric PVS.
Background:
Pulmonary vein stenosis (PVS) is a rare but serious condition in children, often requiring surgical or catheter-based interventions. The initial optimal treatment strategy remains unclear due to disease complexity, progression, and high rates of recurrence.
Methods:
In this retrospective, single-center study, we identified children with primary or secondary PVS from a cardiac catheterization and surgical database between 2015 and 2023. Patients with single ventricle physiology were excluded. Demographics and outcomes were compared between patients who underwent catheter-based intervention only and those who underwent at least one surgical pulmonary vein repair, with or without subsequent catheter-based reintervention. Reintervention following surgical repair was assessed using Kaplan-Meier analysis.
Results:
Among 56 children with biventricular physiology and PVS (33 males, 59%), 16 (29%) underwent at least one surgical repair at a median age of 9 months (IQR 4-20), while 40 (71%) were managed with catheter-based interventions alone. Surgical repair was more frequently performed in patients with bilateral or complex disease, particularly those without prematurity or with coexisting congenital heart defects requiring open-heart surgery. Over time, catheter-based approaches became increasingly preferred. Overall, 92% of surgical patients required reintervention, most within the first year. Mortality did not significantly differ between groups (p = 0.294). In the surgical group, elevated right ventricular/systemic systolic pressure ratio (HR: 1.25, p = 0.048) and the presence of scimitar syndrome (HR: 8.25, p = 0.011) were associated with increased mortality.
Conclusions:
Surgical pulmonary vein repair remains an important option, particularly in cases where catheter-based intervention is not feasible due to anatomical challenges or when multiple pulmonary veins are severely affected. However, recurrent pulmonary vein re-intervention is common, regardless of whether the initial approach was surgical or catheter-based.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:21Cardiac Catheterization II: Right Heart Catheterization
01:29Venous Thrombosis III: Interprofessional Care