HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gordon K. Danielson Francisco J. Puga William D. Edwards Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Son, J. A. M. Articles by Driscoll, D. J. Search for Related Content PubMed PubMed Citation Articles by van Son, J. A. M. Articles by Driscoll, D. J.

Ann Thorac Surg 1995;60:144-150
© 1995 The Society of Thoracic Surgeons

Repair of Congenital and Acquired Pulmonary Vein Stenosis

Divisions of Thoracic and Cardiovascular Surgery and Anatomic Pathology and Section of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota

Accepted for publication March 15, 1995.

	Abstract

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Background. Congenital pulmonary vein stenosis is a rare cause of obstruction of pulmonary venous blood flow with a high mortality. Acquired pulmonary vein stenosis is an equally serious condition.

Methods. Eight patients (age range, 3 months to 43 years; median age, 1.5 years) underwent surgical relief of pulmonary vein stenosis. Two had congenital pulmonary vein stenosis, 5 had pulmonary vein stenosis that was acquired after surgical treatment of total anomalous pulmonary venous connection, and 1 had pulmonaryvein stenosis associated with idiopathic mediastinal fibrosis and calcification.

Results. One infant died 2 months after correction of acquired pulmonary vein stenosis. At follow-up extending to 16 years (median follow-up, 6.5 years), 6 patients are in New York Heart Association functional class I, and 1 patient is in class II.

Conclusions. In view of the dismal natural history of untreated pulmonary vein stenosis, prompt surgical relief of the stenosis may be a rewarding undertaking.

	Introduction

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Congenital pulmonary vein stenosis is a morphologic and functional narrowing of the junctional area between one or more pulmonary veins and the left atrium, with or without involvement of the adjacent extrapulmonary venous segment. It is a rare cause of obstruction of pulmonary venous blood flow with a high mortality [1–10]. The development of pulmonary venous obstruction after correction of partial or total anomalous pulmonary venous connection (TAPVC) is a similarly serious condition [11–24]. To learn more about the outcome in surgical patients, we reviewed our experience with repair of congenital and acquired pulmonary venous obstruction.

	Material and Methods

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Eight patients with pulmonary venous obstruction, 6 of whom were white and 2, Eskimo, were operated on at the Mayo Clinic between 1978 and 1993. The patient data are summarized in Table 1. The age of the patients at operation ranged from 3 months to 43 years (mean age, 10.2 years; median age, 1.5 years). Five patients (patients 1 through 5; see Table 1) had pulmonary venous obstruction after surgical correction of TAPVC. Three of these patients had their primary operation at the Mayo Clinic, for an incidence of pulmonary venous obstruction after correction of TAPVC of 3.8% (3/78), and 2 had their primary operation elsewhere. The interval between primary operation and reoperation for pulmonary vein stenosis ranged from 2 months to 25 years (median interval, 2 years).

Symptoms consisted of dyspnea (n = 8) and increased pulmonary infections (n = 5). In all patients, the diagnosis of pulmonary vein stenosis was made by cardiac catheterization (Figs 1, 2). In 2 recent patients, transesophageal echocardiography confirmed the diagnosis. Patients with pulmonary venous obstruction after a previous Mustard, Senning, or Fontan operation were excluded from this series.

View larger version (177K): [in this window] [in a new window]   Fig 1. . (Patient 6.) Congenital pulmonary vein stenosis: pulmonary venous angiogram (posteroanterior projection) demonstrates discrete stenosis (arrow) in left upper pulmonary vein (LA = left atrium.)

View larger version (143K): [in this window] [in a new window]   Fig 2. . (Patient 7.) Congenital pulmonary vein stenosis: pulmonary venous angiogram (posteroanterior projection) demonstrates discrete narrowing (arrow) in right upper pulmonary vein near its entrance to left atrium.

In 7 patients (patients 1 through 6 and 8), the pulmonary vein stenoses were approached through a right atriotomy and incision of the atrial septum. In 1 patient (patient 7), the stenotic right pulmonary veins were approached through a left atriotomy at the right interatrial groove.

Pulmonary Venous Obstruction After Correction of TAPVC
SUPRACARDIAC TYPE (PATIENT 1).
In this patient at age 3 months, a left vertical pulmonary vein was ligated, and the common pulmonary vein was anastomosed side-to-side to the left atrium; the ASD was closed with a Dacron patch. At reoperation 3 months later, the Dacron patch was covered with a thick layer of neointima and was contracted. In addition, excessive fibrous tissue was present at the right and left common pulmonary vein orifices. The right orifice measured only 2 mm and the left orifice, 5 mm. The Dacron patch was excised, the fibrous tissue at both common pulmonary vein orifices was resected, and lateral incisions were made from both orifices to the individual superior and inferior pulmonary veins. The ASD, atrial septum, and right atriotomy were closed with a generous autologous pericardial patch (Fig 3).

View larger version (103K): [in this window] [in a new window]   Fig 3. . (Patient 1.) Relief of common pulmonary vein–left atrial anastomotic stenosis after repair of supracardiac total anomalous pulmonary venous connection. (A) Transverse right atriotomy. (B) The atrial septal defect (ASD) patch was excised, fibrous tissue at both common pulmonary vein orifices was resected, and right and left lateral incisions were made on both sides out to the individual superior and inferior pulmonary veins. (C, D). The left atrial edges were sutured to the pulmonary vein edges where necessary, and the ASD, atrial septum, and right atriotomy were closed with a generous autologous pericardial patch. (Ao = aorta; LA = left atrium; RA = right atrium; RV = right ventricle.)

Five months later, increasing dyspnea developed. Angiography demonstrated severe stenoses of the orifices of both right pulmonary veins. At reoperation at 7 months, there was dense fibrosis of the mediastinum. The previously inserted pericardial baffle had contracted, and the flow pathway between the right pulmonary veins and the left atrium was atretic. Stenotic orifices of the right pulmonary veins were dilated from 12 to 18 mm. A generous patch of preserved dura mater was used to construct a new baffle from the right pulmonary veins to the ASD and left atrium. An 18-mm probe could be passed beneath the baffle. A second generous patch of dura mater was used to enlarge the superior vena cava at its entrance into the right atrium.

In patient 3, the left lower pulmonary vein and the right pulmonary veins drained into the coronary sinus, and the left upper pulmonary vein drained into a left vertical vein. At the primary operation, the roof of the coronary sinus was excised to connect the coronary sinus to the left atrium. A pericardial patch was then sewn over the mouth of the coronary sinus and ASD so as to direct the coronary sinus and pulmonary venous blood to the left atrium [25]. At reoperation, there was a stenosis at the common pulmonary vein entrance to the left atrium. The ostium of the common pulmonary vein was incised toward the right to the level of entry of the individual right superior and inferior pulmonary veins; both veins then admitted 6-mm probes. The left lower lobe vein was freed so that it also admitted a 6-mm probe. The atrial septum was closed with an autologous pericardial patch.

INFRACARDIAC TYPE (PATIENTS 4 AND 5).
In patient 4, the primary operation consisted of anastomosis of the vertical segment of the common pulmonary vein to the left atrium and closure of the ASD. At reoperation, the anastomosis was enlarged by incising it to the right and closing the atrial septum with an autologous pericardial patch. In addition, there was a stenosis at the orifice of the left upper pulmonary vein; this was dilated. The descending vein that communicated with the portal vein was still patent; therefore it was ligated.

Patient 5 had primary repair of infracardiac TAPVC and closure of the ASD at 12 days of age elsewhere. At reoperation, the severely stenotic anastomosis between the common pulmonary vein and the left atrium was enlarged by excising the common septum between the left atrium and the right pulmonary veins. A residual ASD was closed with a Dacron patch.

Congenital Pulmonary Vein Stenosis
Patient 6 had stenosis of the left upper pulmonary vein (see Fig 1), a small ASD, and a small perimembranous VSD. At operation when he was 10 months of age, the stenotic orifice of the left upper pulmonary vein was dilated until it was the same size as the other pulmonary vein orifices. The ASD and VSD were closed by sutures.

Patient 7 had transposition of the great arteries, subarterial VSD, patent ductus arteriosus, and an ASD. At another institution when she was 2 weeks of age, the patient had undergone ligation of the patent ductus arteriosus through a left thoracotomy and subsequently a Blalock-Hanlon atrial septectomy and creation of a right modified Blalock-Taussig shunt through a right thoracotomy. At reoperation at our institution when she was 1 year of age, the orifices of both right pulmonary veins had fibrotic stenoses (see Fig 2). The fibrous tissue was resected, and the orifices of both right pulmonary veins were incised and enlarged with an autologous pericardial patch (Fig 4). An arterial switch operation with a Lecompte maneuver, patch closure of the VSD, and suture closure of the ASD were then performed.

View larger version (146K): [in this window] [in a new window]   Fig 4. . (Patient 7.) Relief of right congenital pulmonary vein stenoses. (A) A longitudinal incision was made in the left atrium (LA) anterior to the right pulmonary veins (RPV), and orthogonal incisions were made into the right upper and lower veins and carried to their bifurcations. (B) The entire area was closed and enlarged with an autologous pericardial patch. (Ao = aorta; LPA = left pulmonary arteries; LPV = left pulmonary veins; RA = right atrium; RPA = right pulmonary arteries; RV = right ventricle.)

A right atriotomy was made with a T extension posteriorly into the left atrium and another extension medially into the atrial septum. The atrial septal incision was extended laterally across the right lower pulmonary vein stenosis and distally to the lower pulmonary vein bifurcation, which received blood from the middle and right lower lobes. The entire area was enlarged with an autologous pericardial patch. The initial diameter of the right lower pulmonary vein was 13.5 mm (143 mm²), and the diameter after patch enlargement was 16.5 mm (214 mm²), a 50% increase in cross-sectional area. The patch was carried up to the level of the atrial septum, the atrial septal incision was closed with a second patch of autologous pericardium, and the first patch was then continued up to close the T extension of the right atriotomy.

Histologic examination of the right middle lobe biopsy sample showed severe, widespread pulmonary venous and arterial obstructions caused by intimal smooth muscle proliferation, fibrosis, and old, partially recanalized thrombi (Fig 5). These findings are consistent with constriction of pulmonary vessels by mediastinal or pulmonary hilar fibrosis.

View larger version (159K): [in this window] [in a new window]   Fig 5. . Photomicrographs of secondary pulmonary vascular disease associated with acquired pulmonary vein stenosis. Luminal stenosis, caused by intimal proliferation and fibrosis, involves (A) pulmonary veins, (B) venules, (C) arterioles, and (D) arteries. (Elastic–van Gieson's stains; A, B, D, x90 and C, x180 before 34% reduction.)

	Results

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

Follow-up for all 8 patients was complete and ranged from 2 months to 16 years (median follow-up, 6.5 years; mean follow-up, 7.5 years). One Eskimo patient (patient 3) died at home at the age of 5 months, 2 months after operation. A postmortem examination was not performed.

One patient (patient 2) who underwent incomplete repair of TAPVC elsewhere at the age of 1 year and who, 25 years later, had completion of the repair at our institution, at last follow-up had severe pulmonary hypertension with a pulmonary artery pressure of 125/55 mm Hg, a right ventricular pressure of 125/25 mm Hg, and a pulmonary capillary wedge pressure of 29 mm Hg. Angiography showed adequate patency of the pulmonary veins. The patient is being treated with calcium-channel blockers and digoxin and is currently in New York Heart Association functional class II. The other 6 patients are in functional class I. Four of these patients had echocardiographic follow-up (3 by transesophageal echocardiography), which showed adequate patency of the pulmonary veins.

	Comment

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Congenital pulmonary vein stenosis can appear in patients without other congenital heart disease, but it frequently coexists with such congenital heart defects as TAPVC, transposition of the great arteries, VSD, and other anomalies [8]. The basic pathologic process is a nonspecific fibrous intimal thickening, which may progress to complete obliteration of the lumen, between one or more pulmonary veins and the left atrium [2]. The stenosis can be discrete and is then usually located at the orifice of the pulmonary vein [2–4], or it can also involve the adjacent extrapulmonary venous segment in a tubular fashion [8, 9].

The reported incidence of pulmonary venous obstruction after repair of TAPVC ranges up to 18% [11–24]. Symptomatic obstruction usually occurs within the first 6 months after repair of TAPVC, although 3 of the 5 patients in our series were seen late (at 2, 8, and 25 years). Pulmonary venous obstruction after repair of TAPVC can be caused by anastomotic stenosis secondary to technical failure, differential growth of the venous anastomosis and the pulmonary vein involved, neointimal tissue overgrowth on the surface of an artificial patch, or intimal hyperplasia within the individual pulmonary veins unrelated to the operative site [14, 24]. Jenkins and colleagues [26] reviewed the size of the individual pulmonary veins and related this to outcome in infants less than 4 months old at presentation. They found that the sum of the diameters of the individual pulmonary veins indexed for body surface area was significantly larger in survivors without obstruction than in patients who died without operation, those in whom obstruction developed, or those who died late. They concluded that size of the pulmonary veins is an important determinant of outcome in patients with TAPVC.

In an autopsy study, Haworth and Reid [27] examined in detail the pulmonary vasculature in infants with TAPVC and pulmonary venous obstruction. They observed increased wall thickness (intimal and medial hypertrophy) of arteries and veins, arterialization of veins, and abnormal extension of smooth muscle cells into the small intra-acinar arteries. These findings have been confirmed by other studies [28–30] and are identical to the classic histologic findings of chronic pulmonary venous hypertension (as present, eg, in mitral stenosis) [31]. Although it appears that the pulmonary venous changes that occur with TAPVC are reversible if corrected at an early age and pulmonary artery pressure can normalize [32], the thick-walled extrapulmonary veins may not grow and may undergo further intimal proliferation and fibrosis [28]. Presumably, such stenoses are becoming more apparent now that more infants are surviving primary repair of TAPVC [21–23].

One patient in this report had a different form of acquired pulmonary vein stenosis, ie, idiopathic mediastinal fibrosis, which is known to be capable of involving pulmonary veins as well as any other mediastinal structure [33, 34]. The disease had progressed rapidly, and the only source of pulmonary venous return to the left atrium was through a stenotic right lower lobe pulmonary vein. Although the etiology of mediastinal fibrosis is frequently unknown, at one time, tuberculosis and syphilis were suspected causes [33]. It is also a well-documented sequela of exposure to Histoplasma capsulatum [34].

Generally, the prognosis for patients with congenital or acquired pulmonary vein stenosis is poor, particularly if all veins are affected [1–10, 14, 23, 24, 34]. Although progression of symptoms may be less rapid if only one or two pulmonary veins are involved [10], progression to bilateral pulmonary vascular disease and death is usually the rule, even in initially less severe cases [1–9, 24].

The incidence of anastomotic stenoses after repair of TAPVC can be reduced by the creation of generous anastomoses between the pulmonary venous structures and the left atrium; in this regard, the open technique of anastomosis is preferable to the use of clamps [12]. In the infracardiac type of TAPVC, incision of the anterior surface of the vertical segment of the common pulmonary vein with extension through the confluence of the pulmonary veins (Y incision) allows a wide anastomosis to the left atrium, up to the tip of the atrial appendage [35]; in some cases, patching the atrial septum with autologous pericardium may be useful to increase the size of the left atrium. The use of absorbable suture (polyglyconate or polydioxanone) [36] or an interrupted suture technique [37] may decrease the incidence of anastomotic obstruction owing to less limitation of growth of the low-pressure anastomosis. Maneuvers that increase pulmonary venous pressure during operation for TAPVC, such as snaring of pulmonary veins, are best avoided [38]. No measures are currently available to prevent excessive fibrous tissue formation at the surgical sites, a cause of late pulmonary venous stenosis in some patients.

Two-dimensional echocardiography with pulsed Doppler examination and color-flow imaging provides an accurate method of identifying and localizing pulmonary venous obstruction and quantifying its degree [23]. Percutaneous balloon dilation and placement of currently available stents in stenotic pulmonary veins have usually provided only temporary relief [10, 39], but improved intravascular stents may offer better palliation in the future. The first reported successful surgical repair of congenital pulmonary vein stenosis was by Kawashima and co-workers [40] in 1971. In subsequent reports of surgical treatment of congenital pulmonary vein stenosis, the early and late mortality has been high [9, 10, 41, 42], and only sporadically have good early and intermediate-term results been reported [37, 43]. Both patients with congenital pulmonary vein stenosis in our series currently are in New York Heart Association functional class I with follow-up of 5 years and 10 years.

In mild pulmonary vein stenosis, intraoperative dilation may be all that is needed. We believe that it is preferable to use autologous pericardial tissue or atrial tissue for patch enlargement of severe pulmonary vein stenoses. Whenever possible, the use of artificial or allograft patches should be avoided, as they may induce neointimal formation with increased need of reoperation [20]. The techniques described by Pacifico and associates [37] for relief of pulmonary vein stenosis with the use of atrial wall or atrial septal tissue may be useful in select cases. If relief of pulmonary venous obstruction is not possible, it may be necessary to excise undrained pulmonary tissue to prevent irreversible pulmonary vascular disease [42]. In the case of congenital or acquired pulmonary vein stenosis that is beyond repair and that is associated with end-stage parenchymal lung disease, single- or double-lung transplantation may be indicated [44].

It summary, the results of this study suggest that prompt surgical relief of pulmonary venous obstruction, whether congenital in origin, caused by anastomotic stenosis or pulmonary vein hyperplasia after repair of TAPVC, or associated with mediastinal fibrosis, may lead to good long-term results.

	Acknowledgments

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
We appreciate the opportunity to include data from patients operated on by Dr Dwight C. McGoon.

	Footnotes

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 
Address reprint requests to Dr Danielson, Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.

	References

Top Footnotes Abstract Introduction Material and Methods Results Comment Acknowledgments References

 

1. Reye D. Congenital stenosis of the pulmonary veins in their extrapulmonary course. Med J Austr 1951;1:801–2.
2. Emslie-Smith D, Hill IGW, Lowe KG. Unilateral membranous pulmonary venous occlusion, pulmonary hypertension, and patent ductus arteriosus. Br Heart J 1955;17:79–84.
3. Bernstein J, Nolke AC, Reed JO. Extrapulmonic stenosis of the pulmonary veins. Circulation 1959;19:891–7.[Abstract/Free Full Text]
4. Shone JD, Amplatz K, Anderson RC, Adams P Jr, Edwards JE. Congenital stenosis of individual pulmonary veins. Circulation 1962;26:574–81.[Abstract/Free Full Text]
5. Edwards J. Congenital stenosis of pulmonary veins. Lab Invest 1960;9:46–66.[Medline]
6. Lucas R, Anderson R, Amplatz K, Adams P, Edwards J. Congenital causes of pulmonary venous obstruction. Pediatr Clin North Am 1963;10:781–836.
7. Contis G, Fung RH, Vawter GF, Nadas AS. Stenosis and obstruction of the pulmonary veins associated with pulmonary artery hypertension. Am J Cardiol 1967;20:718–24.[Medline]
8. Mortensson W, Lundström NR. Congenital obstruction of the pulmonary veins at their atrial junctions. Review of the literature and a case report. Am Heart J 1974;87:359–62.[Medline]
9. Bini RM, Cleveland DC, Ceballos R, Bargeron LM Jr, Pacifico AD, Kirklin JW. Congenital pulmonary vein stenosis. Am J Cardiol 1984;54:369–75.[Medline]
10. Driscoll DJ, Hesslein PS, Mullins CE. Congenital stenosis of individual pulmonary veins: clinical spectrum and unsuccessful treatment by transvenous balloon dilation. Am J Cardiol 1982;49:1767–72.[Medline]
11. Behrendt DM, Aberdeen E, Waterston DJ, Bonham-Carter RE. Total anomalous pulmonary venous drainage in infants. I. Clinical and hemodynamic findings, methods, and results of operation in 37 cases. Circulation 1972;46:347–56.[Abstract/Free Full Text]
12. Breckenridge IM, de Leval M, Stark J, Waterston DJ. Correction of total anomalous pulmonary venous drainage in infancy. J Thorac Cardiovasc Surg 1973;66:447–53.[Medline]
13. Katz NM, Kirklin JW, Pacifico AD. Concepts and practices in surgery for total anomalous pulmonary venous connection. Ann Thorac Surg 1978;25:479–87.[Abstract]
14. Whight CM, Barratt-Boyes BG, Calder AL, Neutze JM, Brandt PWT. Total anomalous pulmonary venous connection. Long-term results following repair in infancy. J Thorac Cardiovasc Surg 1978;75:52–63.[Abstract]
15. Reardon MJ, Cooley DA, Kubrusly L, et al. Total anomalous pulmonary venous return: report of 201 patients treated surgically. Tex Heart Inst J 1985;12:131–41.
16. Galloway AC, Campbell DN, Clarke DR. The value of early repair for total anomalous pulmonary venous drainage. Pediatr Cardiol 1985;6:77–81.[Medline]
17. Yee ES, Turley K, Hsieh WR, Ebert PA. Infant total anomalous pulmonary venous connection: factors influencing timing of presentation and operative outcome. Circulation 1987;76(Suppl III):83–7.
18. Jonas A, Smolinsky A, Mayer JE, Castaneda AR. Obstructed pulmonary venous drainage with total anomalous pulmonary venous connection to the coronary sinus. Am J Cardiol 1987;59:431–5.[Medline]
19. Schäfers H-J, Luhmer I, Oelert H. Pulmonary venous obstruction following repair of total anomalous pulmonary venous drainage. Ann Thorac Surg 1987;43:432–4.[Abstract]
20. Lamb RK, Qureshi SA, Wilkinson JL, Arnold R, West CR, Hamilton DI. Total anomalous pulmonary venous drainage. Seventeen-year surgical experience. J Thorac Cardiovasc Surg 1988;96:368–75.[Abstract]
21. Sano S, Brawn WJ, Mee RBB. Total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg 1989;97:886–92.[Abstract]
22. Serraf A, Bruniaux J, Lacour-Gayet F, et al. Obstructed total anomalous pulmonary venous return. Toward neutralization of a major risk factor. J Thorac Cardiovasc Surg 1991;101:601–6.[Abstract]
23. Van der Velde ME, Parness IA, Colan SD, et al. Two-dimensional echocardiography in the pre and postoperative management of totally anomalous pulmonary venous connection. J Am Coll Cardiol 1991;18:1746–51.[Abstract]
24. Van de Wal HJCM, Hamilton DI, Godman MJ, Harinck E, Lacquet LK, van Oort A. Pulmonary venous obstruction following correction for total anomalous pulmonary venous drainage: a challenge. Eur J Cardio-thorac Surg 1992;6:545–9.[Abstract]
25. Van Praagh R, Harken AH, Delisle G, Ando M, Gross RE. Total anomalous pulmonary venous drainage to the coronary sinus. A revised procedure for its correction. J Thorac Cardiovasc Surg 1972;64:132–5.[Medline]
26. Jenkins KJ, Sanders SP, Coleman L, Mayer JE, Colan SD. Pulmonary vein size and outcome in infants with totally anomalous pulmonary venous connection. Circulation 1991;84(Suppl 2):351.
27. Haworth SG, Reid L. Structural study of pulmonary circulation and of heart in total anomalous pulmonary venous return in early infancy. Br Heart J 1977;39:80–92.[Abstract/Free Full Text]
28. Haworth SG. Total anomalous pulmonary venous return. Prenatal damage to pulmonary vascular bed and extrapulmonary veins. Br Heart J 1982;48:513–24.[Abstract/Free Full Text]
29. Newfeld EA, Wilson A, Paul MH, Reisch JS. Pulmonary vascular disease in total anomalous pulmonary venous drainage. Circulation 1980;61:103–9.[Abstract/Free Full Text]
30. Petersen RC, Edwards WD. Pulmonary vascular disease in 57 necropsy cases of total anomalous pulmonary venous connection. Histopathology 1983;7:487–96.[Medline]
31. Wagenvoort CA. Lung biopsy specimens in the evaluation of pulmonary vascular disease. Chest 1980;77:614–25.[Abstract/Free Full Text]
32. Norwood WI, Hougen TJ, Castaneda AR. Total anomalous pulmonary venous connection: surgical considerations. Cardiovasc Clin 1981;11:353–64.[Medline]
33. Dye TE, Saab SB, Almond CH, Watson L. Sclerosing mediastinitis with occlusion of pulmonary veins. Manifestations and management. J Thorac Cardiovasc Surg 1977;74:137–41.[Abstract]
34. Mathisen DJ, Grillo HC. Clinical manifestation of mediastinal fibrosis and histoplasmosis. Ann Thorac Surg 1992;54:1053–8.[Abstract]
35. Phillips SJ, Kongtahworn C, Zeff RH, Skinner JR, Chandramouli B, Gay JH. Correction of total anomalous pulmonary venous connection below the diaphragm. Ann Thorac Surg 1990;49:734–9.[Abstract]
36. Hawkins JA, Minich LL, Tani LY, Ruttenberg HD, Sturtevant JE, McGough EC. Absorbable polydioxanone suture and results in total anomalous pulmonary venous connection. Ann Thorac Surg 1995;60:55–9.[Abstract/Free Full Text]
37. Pacifico AD, Mandke NV, McGrath LB, Colvin EV, Bini RM, Bargeron LM Jr. Repair of congenital pulmonary venous stenosis with living autologous atrial tissue. J Thorac Cardiovasc Surg 1985;89:604–9.[Abstract]
38. Gomes MMR, Feldt RH, McGoon DC, Danielson GK. Total anomalous pulmonary venous connection. Surgical considerations and results of operation. J Thorac Cardiovasc Surg 1970;60:116–22.[Medline]
39. O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation 1991;83:1923–39.[Abstract/Free Full Text]
40. Kawashima Y, Ueda T, Naito Y, Morikawa E, Manabe H. Stenosis of pulmonary veins: report of a patient corrected surgically. Ann Thorac Surg 1971;12:196–202.[Medline]
41. Park SC, Neches WH, Lenox CC, Zuberbuhler JR, Siewers RD, Bahnson HT. Diagnosis and surgical treatment of bilateral pulmonary vein stenosis. J Thorac Cardiovasc Surg 1974;67:755–61.[Medline]
42. Sade RM, Freed MD, Matthews EC, Castaneda AR. Stenosis of individual pulmonary veins. Review of the literature and report of a surgical case. J Thorac Cardiovasc Surg 1974;67:953–62.[Medline]
43. Binet JP, Bouchard F, Langlois J, Chetochine F, Conso JF, Pottemain M. Unilateral congenital stenosis of the pulmonary veins. A very rare cause of pulmonary hypertension. J Thorac Cardiovasc Surg 1972;63:397–402.[Medline]
44. Mendeloff EN, Spray TL, Huddleston CB, Canter CE, Bridges ND. Lung transplantation for congenital pulmonary vein stenosis. Ann Thorac Surg (in press).

This article has been cited by other articles:

				M. L. Brown, A. R. Cedeno, E. S. Edell, D. J. Hagler, and H. V. Schaff Operative strategies for pulmonary artery occlusion secondary to mediastinal fibrosis. Ann. Thorac. Surg., July 1, 2009; 88(1): 233 - 237. [Abstract] [Full Text] [PDF]

				M. Mutsuga, Y. Narita, A. Yamawaki, M. Satake, H. Kaneko, A. Usui, and Y. Ueda Development of novel drug-eluting biodegradable nano-fiber for prevention of postoperative pulmonary venous obstruction, Interactive CardioVascular and Thoracic Surgery, April 1, 2009; 8(4): 402 - 407. [Abstract] [Full Text] [PDF]

				U. K. Chowdhury, B. Airan, A. Malhotra, A. K. Bisoi, A. Saxena, S. S. Kothari, M. Kalaivani, and P. Venugopal Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 106 - 116. [Abstract] [Full Text] [PDF]

				S. Takabayashi, H. Shimpo, K. Yokoyama, M. Kajimoto, and K. Onoda Congenital Pulmonary Vein Stenosis with Anomalous Pulmonary Venous Connection Asian Cardiovasc Thorac Ann, October 1, 2007; 15(5): 438 - 440. [Abstract] [Full Text] [PDF]

				A N Seale, P E F Daubeney, A G Magee, and M L Rigby Pulmonary vein stenosis: initial experience with cutting balloon angioplasty Heart, June 1, 2006; 92(6): 815 - 820. [Abstract] [Full Text] [PDF]

				D. L. Packer, P. Keelan, T. M. Munger, J. F. Breen, S. Asirvatham, L. A. Peterson, K. H. Monahan, M. F. Hauser, K. Chandrasekaran, L. J. Sinak, et al. Clinical Presentation, Investigation, and Management of Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation Circulation, February 8, 2005; 111(5): 546 - 554. [Abstract] [Full Text] [PDF]

				A. Kluge, T. Dill, O. Ekinci, J. Hansel, C. Hamm, H. F. Pitschner, and G. Bachmann Decreased Pulmonary Perfusion in Pulmonary Vein Stenosis After Radiofrequency Ablation: Assessment With Dynamic Magnetic Resonance Perfusion Imaging Chest, August 1, 2004; 126(2): 428 - 437. [Abstract] [Full Text] [PDF]

				E. Villa, E. Le Bret, A. Batisse, and P. Vouhe Obstructed right pulmonary venous drainage and ipsilateral lung hypoplasia Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 899 - 901. [Abstract] [Full Text] [PDF]

				A. M. Qureshi, L. R. Prieto, L. A. Latson, G. K. Lane, C. I. Mesia, P. Radvansky, R. D. White, N. F. Marrouche, E. B. Saad, D. L. Bash, et al. Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation Circulation, September 16, 2003; 108(11): 1336 - 1342. [Abstract] [Full Text] [PDF]

				M. Ricci, M. Elliott, G.A. Cohen, G. Catalan, J. Stark, M.R. de Leval, and V.T. Tsang Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 28 - 36. [Abstract] [Full Text] [PDF]

				S. M. Jaillard, F. R. Godart, T. Rakza, A. Chanez, P. Lequien, A. J. Wurtz, and L. Storme Acquired pulmonary vein stenosis as a cause of life-threatening pulmonary hypertension Ann. Thorac. Surg., January 1, 2003; 75(1): 275 - 277. [Abstract] [Full Text] [PDF]

				G. P. Ussia, M. Marasini, L. Zannini, and G. Pongiglione Acquired pulmonary vein obstruction after open-heart surgery Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 465 - 467. [Abstract] [Full Text] [PDF]

				M. Ito, S. Kikuchi, Y. Hachiro, and T. Abe Congenital pulmonary vein stenosis associated with cor triatriatum Ann. Thorac. Surg., February 1, 2001; 71(2): 722 - 723. [Abstract] [Full Text] [PDF]

				G. W. Taylor, G. N. Kay, X. Zheng, S. Bishop, and R. E. Ideker Pathological Effects of Extensive Radiofrequency Energy Applications in the Pulmonary Veins in Dogs Circulation, April 11, 2000; 101(14): 1736 - 1742. [Abstract] [Full Text] [PDF]

				M. Endo, S. Yamaki, M. Ohmi, and K. Tabayashi Pulmonary vascular changes induced by congenital obstruction of pulmonary venous return Ann. Thorac. Surg., January 1, 2000; 69(1): 193 - 197. [Abstract] [Full Text] [PDF]

				M. Remy-Jardin and J. Remy Spiral CT Angiography of the Pulmonary Circulation Radiology, September 1, 1999; 212(3): 615 - 636. [Abstract] [Full Text]

				J. P. Breinholt, J. A. Hawkins, L. Minich, L. Y. Tani, G. S. Orsmond, S. Ritter, and R. E. Shaddy Pulmonary vein stenosis with normal connection: associated cardiac abnormalities and variable outcome Ann. Thorac. Surg., July 1, 1999; 68(1): 164 - 168. [Abstract] [Full Text] [PDF]

				I. M. Robbins, E. V. Colvin, T. P. Doyle, W. E. Kemp, J. E. Loyd, W. S. McMahon, and G. N. Kay Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation Circulation, October 27, 1998; 98(17): 1769 - 1775. [Abstract] [Full Text] [PDF]

				J. A.M. van Son, J.o. Hambsch, and F. W. Mohr Modified Repair of Mixed Anomalous Pulmonary Venous Connection Ann. Thorac. Surg., May 1, 1998; 65(5): 1441 - 1442. [Abstract] [Full Text] [PDF]

				H. K. Najm, C. A. Caldarone, J. Smallhorn, and J. G. Coles A sutureless technique for the relief of pulmonary vein stenosis withthe use of in situ pericardium J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 468 - 470. [Full Text] [PDF]

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gordon K. Danielson Francisco J. Puga William D. Edwards Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Son, J. A. M. Articles by Driscoll, D. J. Search for Related Content PubMed PubMed Citation Articles by van Son, J. A. M. Articles by Driscoll, D. J.