Pulmonary vein stenosis after pediatric heart transplantation: incidence and risk factors
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By
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Hyun Soo Lee
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Han Ki Park
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Sang On Lee
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Yu Rim Shin
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May 28, 2026
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Clinical Scorecard: Incidence and Risk Factors of Pulmonary Vein Stenosis Following Heart Transplantation in Children
At a Glance
| Category | Detail |
|---|
| Condition | Pulmonary Vein Stenosis (PVS) |
| Key Mechanisms | Progressive neointimal proliferation and obstruction of pulmonary venous return. |
| Target Population | Pediatric heart transplant recipients (<18 years) |
| Care Setting | Single-center pediatric heart transplantation |
Key Highlights
- 18% of pediatric heart transplant recipients developed de novo PVS.
- Congenital heart disease (CHD) is the strongest risk factor for PVS.
- Median time to diagnosis of PVS was 84 days post-transplant.
- PVS did not significantly affect survival probability.
- Donor–recipient size mismatch parameters were greater among patients with PVS.
Guideline-Based Recommendations
Diagnosis
- PVS defined as a ≥ 4 mmHg Doppler gradient across any pulmonary vein or significant narrowing on CT.
Management
- Post-HTx surveillance includes echocardiography and CT at 1 month, 6 months, and annually thereafter.
Monitoring & Follow-up
- Routine imaging to assess for PVS post-transplant.
Risks
- CHD, predicted heart mass (PHM), and male-to-female donor–recipient mismatch are associated with PVS.
Patient & Prescribing Data
Pediatric patients undergoing heart transplantation.
Identification of high-risk groups for surveillance and preventive strategies is essential.
Clinical Best Practices
- Conduct comprehensive pre-transplant evaluations to confirm absence of pre-existing PVS.
- Utilize a multi-modal imaging protocol for post-transplant surveillance.
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