Transthoracic Echocardiographic Markers of Pulmonary Vein Stenosis Requiring Transcatheter Intervention in Premature Infants.

Pulmonary vein stenosis (PVS) is a challenging diagnosis, especially in premature infants. Echocardiography is often used as the primary screening tool in this population, but its accuracy in identifying PVS requiring intervention remains incompletely defined. We aimed to evaluate echocardiographic parameters associated with the need for pulmonary vein intervention in premature infants with suspected PVS. We performed a retrospective, single-center study evaluating premature infants with PVS requiring intervention (balloon angioplasty or stent placement) from 2012 to 2022. Patients with significant congenital heart disease, anomalous pulmonary venous return, or prior pulmonary vein stenting were excluded. The last echocardiogram prior to catheterization was reviewed, and pulmonary veins were analyzed individually. Parameters assessed included aliasing, subjective narrowing, pulmonary vein mean gradient, pulmonary vein variability index (PVVI), and Doppler tracing returning to baseline. 16 unique patients and 31 pre-catheterization echocardiograms (150 pulmonary veins) were included. Doppler tracing not returning to baseline was sensitive but not specific in identifying veins requiring intervention. In contrast, narrowing and aliasing were more specific but less sensitive. When defining a pulmonary vein as abnormal based on any of the three qualitative parameters, sensitivity and negative predictive values were highest, though specificity remained low. Pulmonary vein gradients and PVVI demonstrated decreasing sensitivity and increasing specificity with increasing thresholds. Echocardiography is a valuable tool to identify pulmonary veins requiring intervention, though no single parameter demonstrated optimal sensitivity and specificity. Pulmonary vein gradients and PVVI may further support identification of abnormal veins requiring intervention.