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Antonio Grimaldi, Anna Chiara Vermi, Matteo Montorfano, Federico Pappalardo, Ottavio Alfieri, Antonio Colombo, Multimodality imaging of iatrogenic pulmonary vein stenosis, European Heart Journal - Cardiovascular Imaging, Volume 13, Issue 5, May 2012, Page 369, https://doi.org/10.1093/ejechocard/jer298
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Extract
Pulmonary vein stenosis after radiofrequency ablation occurs up to 3% and requires prompt diagnosis and treatment. Since clinical presentation is variable, a multimodality imaging approach currently provides an essential framework to address the diagnosis and appropriate treatment.
A 40-year-old woman who had undergone surgical correction of sinus venosus atrial septal defect and partial anomalous pulmonary vein return required a radiofrequency ablation procedure for refractory atrial fibrillation. Subsequently, the patient complained progressive exercise intolerance and dyspnoea. Severely narrowed left upper pulmonary vein stenosis (LUPV) was detected by transoesophageal echocardiography (TEE) (A, left, white arrows), confirmed by venography (A, middle, white arrows) and contrast-enhanced computed tomographic (CT) scan, showing 50% LUPV stenosis (A, right, yellow arrow). Right pulmonary venous drainage appeared properly surgically corrected. TEE also revealed a narrowed left lower pulmonary vein (LLPV) (B, left, white arrow) and CT scan confirmed 70% LLPV ostium stenosis (B, middle, yellow arrow). Since the left lower lung was severely hypoperfused at CT scan, LLPV stenosis was treated first. Magnetic resonance angiography (B, right, white arrow) added further anatomical details and the patient was treated with PTA and stent implantation of LLPV (C, left, arrows; see Supplementary data online, Video S1). After 2 months, a subocclusion of LUPV was treated with additional stent implantation (C, middle, arrows; see Supplementary data online, Video S2 and S3). At follow-up, venography showed the implanted stents along LUPV and LLPV without intrastent restenosis (C, right, arrowheads); TEE showed the implanted stents in short and long-axis (D, left-middle, arrows) device planes with persistent laminar Doppler colour flow along the stents (D, right, arrows).
