Key result
Staged DCB angioplasty and stenting resolves iatrogenic pulmonary vein stenosis in a symptomatic patient.
Drug-coated balloon angioplasty followed by stenting can successfully treat iatrogenic pulmonary vein chronic total occlusion presenting as refractory dyspnea.
Suggests a potential percutaneous salvage strategy for iatrogenic pulmonary vein occlusion; leaves open whether.
BACKGROUND: Iatrogenic pulmonary vein (PV) stenosis results from radiofrequency ablation or surgical trauma, causing venous narrowing that may lead to irreversible pulmonary hypertension if untreated. CASE SUMMARY: A 77-year-old woman with recent mitral valve replacement aided by right upper PV (RUPV) venting, left ventricular pseudoaneurysm repair, and atrial flutter radiofrequency ablation presents with progressive dyspnea. Work-up revealed elevated right-sided intracardiac pressures with regional pulmonary capillary wedge pressure variation and angiographic confirmation of RUPV chronic total occlusion. Treatment included 2 drug-coated balloon (DCB) angioplasties followed by stent placement, with eventually normalized RUPV flow. DISCUSSION: Iatrogenic PV stenosis is suspected in patients with refractory dyspnea after PV intervention. DCB angioplasty reduces restenosis rates in PV chronic total occlusions. When restenosis occurs despite DCB, residual microchannels may facilitate subsequent stenting. TAKE-HOME MESSAGE: Persistent dyspnea with regional pulmonary capillary wedge pressure variation warrants PV stenosis evaluation with dedicated angiography and staged DCB and stent-based intervention.
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Bandla et al. (2026) studied this question. Staged drug-coated balloon angioplasty and stenting successfully treated iatrogenic pulmonary vein stenosis in a patient with persistent dyspnea and regional wedge pressure variation.
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