PEDIATRIC AND CONGENITAL HEART DISEASE Original Studies Comparison of Conventional and Cutting Balloon Angioplasty for Congenital and Postoperative Pulmonary Vein Stenosis in Infants and Young Children Lynn F. Peng, 1,2 MD, James E. Lock, 1,2 MD, Alan W. Nugent, 1,2 MD, Kathy J. Jenkins, 1,2 MD, and Doff B. McElhinney, 1,2 * MD Background: Pulmonary vein stenosis (PVS) is a rare and often lethal condition in chil- dren. The optimal treatment for congenital and postoperative PVS is unknown. Methods and Results: We compared outcomes of conventional balloon angioplasty performed for PVS from 1999 to 2003 against cutting balloon angioplasty performed from 2004 to 2007. A total of 100 previously undilated pulmonary veins in 54 patients were studied: 48 veins dilated with conventional balloons and 52 with cutting balloons. Acute results included significantly reduced gradients and increased lumen diameters with both treatments. Acutely, cutting balloon angioplasty and conventional angio- plasty yielded similar relative reduction of the PVS gradient (median 78% vs. 63%, P 5 0.08) and increase in lumen diameter (median 77% vs. 59%, P 5 0.07). There was one procedural death of a critically ill infant, and four cardiac arrests, but no adverse events necessitating surgical intervention. Survival free from reintervention was poor in both groups, and shorter in the cutting balloon group (73% at 1 month, 11% at 6 months, and 4% at 1 year) than in the conventional angioplasty group (77% at 1 month, 35% at 6 months, and 23% at 1 year; P 5 0.01). Conclusions: Both conventional and cutting balloon angioplasty were effective at decreasing gradient and increasing lumen size acutely in patients with congenital and postoperative PVS, but reintervention was common with both treatments. Both methods of angioplasty provided limited benefit, and neither was curative for this complex disease. V C 2010 Wiley-Liss, Inc. Key words: congenital pulmonary vein stenosis; postoperative pulmonary vein stenosis; cutting balloon angioplasty INTRODUCTION Pulmonary vein stenosis (PVS) is a rare condition in children and that is frequently progressive and often lethal [1–3]. It can be congenital, in association with intracardiac abnormalities or in isolation, or acquired after surgical repair of congenital cardiovascular anomalies such as total or partial anomalous pulmonary venous return [1–4]. Historically, PVS has been treated with surgical and catheter-based therapies aimed at anatomic relief of obstruction within the lumen of indi- vidual vessels [3–13]. Transcatheter therapy typically consists of balloon angioplasty (including high-pressure and/or cutting balloon dilations) or stent placement. In addition to addressing proximal PVS, transcatheter techniques can be used to recanalize vessels with short 1 Department of Cardiology, Children’s Hospital Boston, Bos- ton, Massachusetts 2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Conflict of interest: Nothing to report. Grant sponsors: Christina Capozzi Foundation for Heart Research; Boston Children’s Heart Foundation *Correspondence to: Doff B. McElhinney, MD, Department of Car- diology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. E-mail: doff.mcelhinney@cardio.chboston.org Received 18 November 2009; Revision accepted 24 November 2009 DOI 10.1002/ccd.22405 Published online 9 February 2010 in Wiley InterScience (www. interscience.wiley.com) V C 2010 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 75:1084–1090 (2010)