Infographic1 min read·Published Jul 2026

Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis

Infographic · Jul 2026 · 1 min read

In brief

Retrospective study of 56 children with pulmonary vein stenosis found that while surgical repair was reserved for bilateral or complex disease, 92% required reintervention within the first year. Catheter-based approaches have become increasingly preferred over time, though recurrent intervention remains common regardless of initial treatment modality.

92% of surgical PVS patients required reintervention within the first year, highlighting the aggressive nature of disease recurrence.
Catheter-based interventions are increasingly preferred over surgery, with 71% of patients managed without surgical repair.
Elevated RV/systemic pressure ratio and scimitar syndrome are independent predictors of mortality in surgical PVS patients.
Bilateral or complex PVS more often requires surgical repair, especially when combined with other congenital heart defects.
Recurrent reintervention is common regardless of initial treatment modality, emphasizing the need for long-term surveillance.

Written by the GCMD Library team from the infographic.

The infographic uses a teal and yellow color scheme with illustrated icons including a heart diagram, medical professionals performing surgery, and a stethoscope. Content is organized in sections with headers, bullet points, and highlighted text boxes. The layout flows from top to bottom with key findings emphasized in colored boxes.

Daiji Takajo, Paul J Critser, Awais Ashfaq, Russel Hirsch

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.

The text in the image

Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis | Retrospective Single-center | 56 patients w/ biventricular pulmonary vein stenosis | Compared catheter-based intervention vs. surgical pulmonary vein repair | 2015-2023 | Catheter-based treatment became the preferred initial approach over time | Surgery was reserved for the most complex patients: multiple severely narrowed pulmonary veins | bilateral disease | associated congenital heart defects | 92% of surgical patients needed another procedure | Most repeat procedures occurred within the 1st year | No significant difference in mortality between surgical and catheter-based groups | Conclusion: Consider catheter-based intervention first when anatomy allows. Reserve surgical repair for complex or extensive disease. Repeat procedures are common in both strategies. | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's | https://pubmed.ncbi.nlm.nih.gov/41995823/ | Takajo D et. al. | Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA

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