Recurrent pulmonary vein stenosis potentially aggravated by posterior compression in a patient with asplenia

Pulmonary vein stenosis after repair of total anomalous pulmonary venous connection (TAPVC) is a life-threatening complication that frequently recurs, particularly in patients with asplenia. Although intrinsic mechanisms such as ostial narrowing and progressive neointimal proliferation are well recognized, extrinsic mechanical factors are less commonly emphasized in congenital heart disease. We report a case of recurrent pulmonary vein stenosis in a patient with asplenia in whom intrinsic susceptibility and possible posterior extrinsic compression may have acted synergistically. Serial computed tomography demonstrated persistent proximity between the left pulmonary vein and indwelling enteral feeding tubes. Sustained improvement was achieved after surgical relocation of the left pulmonary vein orifice to a site remote from the tubes. This case suggests that external mechanical influences may represent an underrecognized and potentially modifiable contributor to postoperative pulmonary vein stenosis in high-risk pediatric patients.