Percutaneous treatment of pulmonary vein stenosis: a transoesophageal echocardiography step-by-step guide in diagnosis and treatment

Aims: Acquired severe pulmonary vein stenosis (PVS) is a rare but clinically relevant complication of radiofrequency catheter ablation for atrial fibrillation. Diagnosis is often delayed or missed without a multimodality imaging approach. Once established, percutaneous intervention with balloon angioplasty or pulmonary vein stent implantation represents the preferred therapeutic strategy. Imaging plays a central role in determining the indication for intervention, assessing the severity and extent of disease, and accurately localizing the stenosis, thereby enabling appropriate procedural planning. Methods and results: This practical review provides a comprehensive overview of the role of multimodality imaging in patients with suspected PVS and proposes an integrated workflow for diagnosis, treatment, and follow-up. In addition, it offers a step-by-step illustrated guide to the use of transoesophageal echocardiography during percutaneous intervention, addressing the current lack of standardized protocols. Conclusion: The review is structured to cover diagnostic pathways, procedural guidance, and post-intervention surveillance.