We present a 62-year old male who underwent right single-lung transplantation. An autologous pericardial rim was constructed at implantation, as there was insufficient donor atrial cuff. The patient was discharged home but deteriorated over 12 months resulting in oxygen dependency. Computed tomography scan showed stenosis of the right inferior pulmonary vein. The patient underwent pulmonary vein angioplasty under general anaesthesia in September 2007, which was successful and resulted in significant improvement in clinical status. However, his symptoms recurred 2 months later and a second attempt at angioplasty failed. He died 6 weeks later.