Pulmonary vein stenosis after lung transplantation: a case report and literature review

Abstract

Pulmonary vein stenosis (PVS) is a rare event following lung transplantation which increases the risk of morbidity and mortality. Early detection and rapid treatment of this condition is crucial for its management. Although several reports on PVS have been published, there is little consensus regarding its diagnosis and the methods of management. Here we present our experience with PVS. A 31-year-old man received a left lung transplant for chronic hypersensitivity pneumonitis. One year after his singlelung transplant, he began to develop persistent progressive hypoxemia. Computed tomography (CT) of the chest showed left pleural effusion and thickening of the interlobular septa. The results of bronchoscopy and transbronchial biopsies excluded the possibility of acute rejection or infection. The pleural effusion was transudative with lymphocyte predominance. Computed tomography angiography (CTA) in the left atrium and pulmonary veins demonstrated obvious stenosis of both the upper and lower left pulmonary veins (LLPVs) at the transplant anastomotic site. The patient underwent a catheter-guide stent implantation into the stenotic segment of the upper left pulmonary vein (ULPV), and his pleural effusion and hypoxemia problems were ameliorated. Ten months after the intervention, the patient was in excellent clinical condition.In a literature review, we discuss the importance of identifying PVS early after transplantation, the utility of CTA for diagnosis and the use of pulmonary vein stenting intervention. This review provides a basis for further diagnostic strategies and treatments for PVS following lung transplantation.

Endovascular transatrial stenting of pulmonary vein stenosis after lung transplantation

“…(Table1) [3][4][5][6][7][8]11,12 . Most common clinical presentations were respiratory insufficiency, pulmonar y edema or pleural effusion.…”

“…Twitter: @CeulemansLJ E-mail: laurens.ceulemans@uzleuven.be for PVS following catheter ablation for atrial fibrillation (AF) is well-described 2 , angiopla sty with stenting has rarely been reported post-LTx [3][4][5][6][7][8] .…”

Anastomotic complications after lung transplantation

“…Percutaneous angioplasty with or without vascular endoprothesis is usually successful, with low mortality and morbidity rates, for severe anastomotic stenosis of the pulmonary artery (55). In patients with complete venous obstruction, angioplasty with dilatation and endovascular stent placement may be useful (56), but, on occasion, re-transplantation or lobectomy may be required (57).…”

Pulmonary Vein Stenosis After Single Lung Transplantation

“…PV stenosis remains a rare complication of lung transplantation, with current literature primarily built on case reports. 1 Late postoperative PV stenosis is often caused by anastomosis scar hyperplasia, which can be difficult to diagnose given the nonspecific signs that include pulmonary edema, respiratory failure, and hemodynamic instability. 2 Because PV stenosis raises lobar capillary pressures, this diagnosis should be strongly suspected if there are unexplained elevations in PCWP (as the catheter tip measures PV pressure).…”

“… 2 Our vignette reaffirms how TEE provides important functional information regarding PV stenosis after transplantation and may be particularly useful given the feasibility of bedside evaluation, especially for hemodynamically unstable patients. 1 , 2 …”