Pulmonary Vein Stenosis

This rare anomaly occurs at the entrance of pulmonary veins to the left atrium. Because of the severe consequences of pulmonary venous hypertension, including congestive heart failure and/or pulmonary vascular obstructive disease, surgery to repair this lesion is indicated immediately after discovery, regardless of the age of the patient. Direct repair of the pulmonary vein is performed in the presence of mild-to-moderate stenosis. An alternative repair is sutureless with stitches placed in adjacent pericardium and in the pulmonary vein wall remote from the venotomy.

right pulmonary veins atrial septal detect

Figure 12-35. The stenotic orifice of the left pulmonary veins is seen through the ASD.

Stenosis Veins

stenotic left pulmonary vein orifice

Figure 12-35. The stenotic orifice of the left pulmonary veins is seen through the ASD.

stenotic left pulmonary vein orifice

Left Pulmonary Vein

left upper pulmonary vein base of left atrial appendage

Figure 12-36. The obstruction is near the confluence of the left upper and lower pulmonary veins. A Y-shaped incision is made from the base of the left atrial appendage onto the upper and lower pulmonary veins, respectively.

left upper pulmonary vein base of left atrial appendage

Figure 12-36. The obstruction is near the confluence of the left upper and lower pulmonary veins. A Y-shaped incision is made from the base of the left atrial appendage onto the upper and lower pulmonary veins, respectively.

Figure 12-37. The incision over the area of stenosis is extended onto the left lower pulmonary vein.

Pulmonary Vein Stenosis

Figure 12-37. The incision over the area of stenosis is extended onto the left lower pulmonary vein.

left lower pulmonary vein left lower pulmonary vein

Pulmonary Vein Obstruction

anastomosis

Figure 12-38. Repair is performed by closing the incision as a V. The corner of the incisions over the pulmonary veins is moved to the child's right and stitched to the end of the incision at the base of the left atrial appendage. The closure is longitudinal, while the incision was originally made in a transverse plane from the atrium into the veins.

anastomosis

Figure 12-38. Repair is performed by closing the incision as a V. The corner of the incisions over the pulmonary veins is moved to the child's right and stitched to the end of the incision at the base of the left atrial appendage. The closure is longitudinal, while the incision was originally made in a transverse plane from the atrium into the veins.

Insision Vien

closure of atrial septum

Figure 12-39. The ASD is closed primarily.

closure of atrial septum

Figure 12-39. The ASD is closed primarily.

Cardioplegic Arrest

atrial septum stenotic orifice of right pulmonary veins

Figure 12-40. In another patient and after the cardiopulmonary bypass is established, with aortic clamping, cardioplegic arrest, and profound local cardiac cooling, a right atriotomy is made. Stenosis of the right pulmonary veins is seen through the ASD.

atrial septum caud

Figure 12-40. In another patient and after the cardiopulmonary bypass is established, with aortic clamping, cardioplegic arrest, and profound local cardiac cooling, a right atriotomy is made. Stenosis of the right pulmonary veins is seen through the ASD.

stenotic orifice of right pulmonary veins

Pulmonary Vein Stenosis

right pulmonary vein orifice

Figure 12-41. The area of vein stenosis admits a 1-mm probe.

ceph caud right pulmonary vein orifice

Figure 12-41. The area of vein stenosis admits a 1-mm probe.

Orifice Right Pulmonary Vein

right pulmonary veins caud

Right Pulmonary Artery Stenosis

interrupted stitches in anastomosis

Figure 12-42. By working outside the heart, a transverse incision is made from the atrial wall into the right pulmonary vein and across the area of stenosis. This incision is closed longitudinally with interrupted sutures.

interrupted stitches in anastomosis right pulmonary veins caud

Figure 12-42. By working outside the heart, a transverse incision is made from the atrial wall into the right pulmonary vein and across the area of stenosis. This incision is closed longitudinally with interrupted sutures.

ceph

Figure 12-43. After the repair is completed, a 5-mm probe passes easily through the anastomosis.
Cor Triatriatum Repair
Figure 12-44. To avoid distortion of the vein repair, the laterally positioned ASD is closed with a Dacron® patch.
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