Pulmonary vein stenosis: Anatomic considerations, surgical management, and outcomes

The PVs can take a long, angulated course as they pass from the lung parenchyma to the LA. This angulated course appears to occur due to the fulcrum effect of structures adjacent to the PVs (ie, descending aorta, airway, pulmonary artery, and pericardial reflection). The anatomically focused repair strategy aims to target this long, angulated PV course, which may be the nidus for turbulent blood flow and subsequent PVS. This repair involves extensive takedown of the pericardial reflection, resection of stenosing/scar tissue, and lateralizing/patch augmenting the PV–LA connection with the goal of creating a shorter and straighter pulmonary venous course. Early follow-up suggests improved survival with the anatomically focused repair strategy compared with conventional repair techniques (ie, sutureless and modified sutureless repair).