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FIG 18.25 Systemic venous obstruction, with stents implanted in the obstructed superior and inferior caval pathways in a patient with a Mustard procedure Pulmonary Venous Stenosis Pulmonary venous stenosis can be idiopathic, most commonly in neonates with a history of chronic lung disease, or can follow surgical repair of anomalous pulmonary venous drainage, with or without other congenital cardiac disease There has been an increasing awareness of the condition as an isolated entity, particularly in premature infants In infants and children, pulmonary hypertension and right-sided cardiac failure manifest over time When present in young children, pulmonary vein stenosis is usually a progressive and lifethreatening disease Overall, transcatheter interventions for pulmonary vein stenosis can be highly successful in relieving gradients and improving lumen caliber, although midterm outcomes and survival remain disappointing.163,164 The transcatheter approach includes use of chronic thrombotic obstruction wires to recanalize atretic pulmonary veins, use of cutting balloons to “score” stenotic pulmonary veins, implantation of premounted—or rarely large-diameter unmounted—stents, implantation of drug-eluting stents, and use of drug-coated balloons There has been recent interest in immunomodulatory therapy, administered either systemically or locally.165–167 Hence many practitioners have adopted an approach of using drug-eluting stents in small-caliber (