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Figure 5 Congenital Stenosis of the Left Pulmonary Veins in an 8-Month-Old Girl

(A) Contrast-enhanced angiograms show severe stenosis of the left lower pulmonary vein (LLPV) and mild stenosis of the left upper pulmonary vein (LUPV). Both veins are slightly smaller than the right pulmonary veins (RUPV and RLPV). The left pulmonary artery (LPA) is smaller than the right pulmonary artery (RPA) due to diversion of blood flow to the right lung. (B) Time-velocity curves of the pulmonary veins and pulmonary arteries using phase-contrast imaging. The left pulmonary venous flow data were obtained from just upstream of the stenosis. The left pulmonary veins demonstrate reduced velocity and loss of phasic changes. The LPA has reduced systolic blood flow and a premature systolic peak. The blood flow ratio between the right and left lungs is 73%:27%. (C) Contrast-enhanced angiograms obtained 8 months after the surgical repair of the stenosis show residual tight stenosis of the LUPV and less severe narrowing of the LLPV. Both vessels are much smaller than the right pulmonary veins. The right and left pulmonary arteries remain discrepant in size. (D) Flow curves 8 months after surgery. Left lower pulmonary venous flow velocity is markedly reduced. Left pulmonary arterial systolic flow is further reduced, and there is reversed flow (shaded) in diastole. There is almost no net blood flow to the left lung. LA = left atrium; MPA = main pulmonary artery; RLPV = right lower pulmonary vein; RUPV = right upper pulmonary vein.