scholarly journals IVUS guided drug-coated balloon venoplasty for in-stent restenosis in pulmonary veins stenosis: a case report

2021 ◽  
Author(s):  
Juan J Portero-Portaz ◽  
Juan G Córdoba-Soriano ◽  
Arsenio Gallardo-López ◽  
Jesús M Jiménez-Mazuecos
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Percutaneous Treatment ◽  
Pulmonary Vein Stenosis ◽  
Heart Team ◽  
Stent Restenosis ◽  
Specific Material ◽  
Vein Stenosis ◽  
Pulmonary Veins Stenosis

Abstract Background pulmonary veins stenosis after atrial fibrillation radiofrequency ablation is an uncommon complication. When it occurs, percutaneous treatment is the preferred approach. There is a lack of standardized procedures, and when stenting restenosis is relatively common. Case summary we present a young patient with recurrence of pulmonary vein stenosis after a first percutaneous treatment. The recurrence of haemoptysis and dyspnoea after treatment in pulmonary vein stenosis allowed the diagnosis of significant stenosis again in our patient. In the Heart Team we opted for new percutaneous treatment, using IVUS to optimize the final result. Discussion nowadays, percutaneous approach is preferred and among percutaneous treatments for pulmonary veins stenosis, and stenting has shown better results than ballon angioplasty. Despite this, experience in instent restenosis is limited, and there is a lack of adequate and specific material for its approach. In this case we present the possible role of the IVUS and the drug-coated ballon angioplasty in this entity.

scholarly journals Clinical characteristics of patients with atrial fibrillation suffering from pulmonary vein stenosis after radiofrequency ablation

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988155
Author(s):  
Lingping Xu ◽  
Lei Cui ◽  
Junlong Hou ◽  
Jing Wang ◽  
Bin Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Stent Implantation ◽  
Clinical Characteristics ◽  
Rare Complication ◽  
Pulmonary Veins ◽  
Pulmonary Vein Stenosis ◽  
Stent Restenosis ◽  
Asymptomatic Patients ◽  
Vein Stenosis

Objective Pulmonary vein stenosis (PVS) is a serious complication in patients with atrial fibrillation (AF) receiving radiofrequency catheter ablation (RFCA). We therefore examined these patients’ clinical characteristics in relation to PVS occurrence. Method We retrospectively analyzed the clinical symptoms, diagnostic procedures, and treatment strategies in patients with AF who developed PVS after RFCA. Results Among 205 patients with AF who underwent RFCA, five (2.44%) developed PVS (all men; age 44–64 years; AF history 12–60 months; 2 paroxysmal AF, 3 persistent AF). One patient underwent two RFCA sessions and the others received one. The time to PVS diagnosed by pulmonary vein computed tomography angiography (CTA) was 3 to 21 months. PVS symptoms included dyspnea and hemoptysis. Nine pulmonary veins developed PVS. Single mild PVS occurred in two asymptomatic patients and multiple PVS or single severe PVS in three symptomatic patients who underwent pulmonary vein angiography and stent placement. Symptoms in the three patients significantly improved after stent implantation; however, stent restenosis occurred 1 year later in one case. Conclusion PVS is a rare complication of RFCA for AF that can be diagnosed by CTA. Pulmonary vein stent implantation can remarkably improve the symptoms, but stent restenosis may occur.

scholarly journals Clinical Syndromic Phenotypes and the Potential Role of Genetics in Pulmonary Vein Stenosis

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 128
Author(s):  
Abbas H. Zaidi ◽  
Jessica M. Yamada ◽  
David T. Miller ◽  
Kerry McEnaney ◽  
Christina Ireland ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Pulmonary Vein ◽  
Potential Role ◽  
Pulmonary Veins ◽  
Genetic Diagnosis ◽  
Pulmonary Vein Stenosis ◽  
Pulmonary Venous Obstruction ◽  
Atrioventricular Canal ◽  
Vein Stenosis

Pulmonary vein stenosis (PVS) is a rare, frequently lethal disease with heterogeneous phenotypes and an unclear etiology. Limited studies have reported associations between PVS and congenital heart disease (CHD), chronic lung disease (CLD), and/or prematurity; however, to date, there have been no studies that report detailed clinical syndromic phenotypes and the potential role of genetics in PVS. An existing registry of multivessel PVS patients seen at Boston Children’s Hospital (BCH) was queried between August 2006 and January 2017 for all existing genetic testing data on these patients. PVS was defined as an intraluminal pulmonary venous obstruction in ≥2 vessels with mean pressure gradients > 4 mmHg. One-hundred-and-fifty-seven patients (46% female, with a median age at PVS diagnosis of 3 months) formed the cohort. Seventy-one (45%) patients had available genetic testing information. Of the 71 patients, a likely genetic diagnosis was found in 23 (32%) patients: 13 (57%) were diagnosed with Trisomy 21 (T21), five (22%) with Smith–Lemli–Opitz Syndrome, five (22%) had other pathologic genetic disease, and 24 (33%) had variants of unknown significance. The majority of 13 patients with T21 and PVS had common atrioventricular canal (CAVC) (10, 77%) and all had severe pulmonary hypertension (PHTN), which led to their PVS diagnosis. In our study, PVS was associated with T21, the majority of whom also had CAVC and PHTN. Therefore, complete assessment of the pulmonary veins should be considered for all T21 patients, especially those with CAVC presenting with PHTN. Furthermore, prospective standardized genetic testing with detailed clinical phenotyping may prove informative about potential genetic etiologies of PVS.

scholarly journals Correlation of Intravascular Ultrasound with Histology in Pediatric Pulmonary Vein Stenosis

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 193
Author(s):  
Ryan Callahan ◽  
Zachary Gauthier ◽  
Shuhei Toba ◽  
Stephen P. Sanders ◽  
Diego Porras ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Intravascular Ultrasound ◽  
Pulmonary Veins ◽  
Pulmonary Vein Stenosis ◽  
Elastic Fibers ◽  
Gradual Transition ◽  
Wall Thickening ◽  
Thin Wall ◽  
Myxoid Matrix ◽  
Vein Stenosis

Preliminary intravascular ultrasound (IVUS) images of suspected pediatric intraluminal pulmonary vein stenosis (PVS) demonstrate wall thickening. It is unclear how the IVUS-delineated constituents of wall thickening correlate with the histology. We analyzed six postmortem formalin-fixed heart/lung specimens and four live patients with PVS as well as control pulmonary veins using IVUS and light microscopic examination. In PVS veins, IVUS demonstrated wall thickening with up to two layers of variable echogenicity, often with indistinct borders. Histologically, the veins showed fibroblastic proliferation with areas rich in myxoid matrix as well as areas with abundant collagen and elastic fibers. Discrete vein layers were obscured by scarring and elastic degeneration. A lower reflective periluminal layer by IVUS corresponded with hyperplasia of myofibroblast-like cells in abundant myxoid matrix. The hyper-reflective layer by IVUS extended to the outer edge of the vessel and corresponded to a less myxoid area with more collagen, smooth muscle and elastic fibers. The outer less reflective edge of the IVUS image correlated with a gradual transition into adventitia. Normal veins had a thin wall, correlating with histologically normal cellular and extracellular components, without intimal proliferation. IVUS may provide further understanding of the anatomy and mechanisms of pediatric pulmonary vein obstruction.

scholarly journals Relationship between Clinical Features and Histopathologic Findings in Patients with Pulmonary Vein Stenosis

2019 ◽  
pp. 61-63 ◽  
Author(s):  
Y. Mykychak ◽  
D. Kozhokar ◽  
I. Yusifli ◽  
O. Yachnik ◽  
V. Zakharova ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Clinical Features ◽  
Pulmonary Veins ◽  
Clinical Manifestations ◽  
Lung Parenchyma ◽  
Pulmonary Vein Stenosis ◽  
Pathophysiological Mechanism ◽  
Patient Groups ◽  
Vein Stenosis ◽  
Histopathologic Findings

Pulmonary vein stenosis (PVS) is a rare but serious condition characterized by obstruction of extrapulmonary segments of pulmonary veins which leads to progressive pulmonary hypertension. Objective. In this study we aimed to determine relationship between clinical features and histopathologic findings in patients with PVS. Material and methods. We retrospectively reviewed 34 consecutive patients who underwent PV stenosis repair. Surgical wedge biopsy specimens were collected intraoperatively in 11 patients and reviewed using light microscopy. Results. Affected pulmonary veins in patients with primary PVS were characterized by diffuse stenosis extending into the lung parenchyma. In post-surgical group stenosis was found in a limited segment of pulmonary vein at its ostium. Microscopically, abnormal intimal proliferation was identified in both patient groups. Scaring was predominant finding in patients with post-surgical PVS. Conclusion. In patients with PVS, pathophysiological mechanism influences the severity and extent of clinical manifestations. A comprehensive understanding of this mechanism may improve results of the treatment.

scholarly journals Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and Successful Ablation

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
John J. Lee ◽  
Denis Weinberg ◽  
Rishi Anand
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Artery ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Lung Perfusion ◽  
Atrial Fibrillation Ablation ◽  
Clinical Severity ◽  
Pulmonary Vein Stenosis ◽  
Multiple Imaging ◽  
Vein Stenosis

Pulmonary vein stenosis is a well-established possible complication following an atrial fibrillation ablation of pulmonary veins. Symptoms of pulmonary vein stenosis range from asymptomatic to severe exertional dyspnea. The number of asymptomatic patients with pulmonary vein stenosis is greater than originally estimated; moreover, only about 22% of severe pulmonary vein stenosis requires intervention. We present a patient with severe postatrial fibrillation (AF) ablation pulmonary vein (PV) stenosis, which was seen on multiple imaging modalities including cardiac computed tomography (CT) angiogram, lung perfusion scan, and pulmonary angiogram. This patient did not have any pulmonary symptoms. Hemodynamic changes within a stenosed pulmonary vein might not reflect the clinical severity of the obstruction if redistribution of pulmonary artery flow occurs. Our patient had an abnormal lung perfusion and ventilation (V/Q) scan, suggesting pulmonary artery blood flow redistribution. The patient ultimately underwent safe repeat atrial fibrillation ablation with successful elimination of arrhythmia.

Hemoptysis from bronchial varices associated with pulmonary vein stenosis: Role of surgical repair

2012 ◽  
Vol 48 (8) ◽  
pp. 838-840 ◽  
Author(s):  
A. Walsh ◽  
G. Canny ◽  
C.J. McMahon ◽  
J.M. Redmond ◽  
P. McNally
Keyword(s):  
Pulmonary Vein ◽  
Surgical Repair ◽  
Pulmonary Vein Stenosis ◽  
Vein Stenosis

The important role of detecting pulmonary vein stenosis before catheter ablation of atrial fibrillation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S276
Author(s):  
Hsuan-Ming Tsao ◽  
Mei-Han Wu ◽  
Higa Satoshi ◽  
Kun-Tai Lee ◽  
Ching-Tai Tai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Stenosis ◽  
Vein Stenosis

CT Visualization and Histopathological Assessment of Cryoablation in Pulmonary Veins

2009 ◽  
Author(s):  
Mithun M. Shenoi ◽  
Xiaoqing Zhang ◽  
Ramji T. Venkatasubramanian ◽  
Erin D. Grassl ◽  
Lenny George ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
The United States ◽  
The Body ◽  
Pulmonary Vein Stenosis ◽  
Invasive Technique ◽  
Freezing Process ◽  
Ectopic Beats ◽  
Vein Stenosis

Over 2 million adults in the United States are affected by atrial fibrillation (AF), a common cardiac arrhythmia that is associated with decreased survival, increased cardiovascular morbidities, and a decrease in quality of life. Atrial fibrillation can be initiated by ectopic beats originating in the myocardial sleeves surrounding the pulmonary veins [1]. Pulmonary vein (PV) isolation via radiofrequency ablation is the current gold standard for treating patients with drug-refractory AF [2]. However, cryoablation is emerging as a new minimally-invasive technique to achieve PV isolation. Cryoablation is fast gaining acceptance due to its minimal tissue disruption, decreased thrombogenicity, and reduced complications (RF can lead to low rate of pulmonary vein stenosis) [2]. One important question in regard to this technology is whether the PV lesion is transmural and circumferential and to what extent adjacent tissues are involved in the freezing process. As ice formation lends itself to image contrast in the body, we hypothesized that intraprocedural CT visualization of the iceball formation would allow us to predict the extent of the cryolesion and/or provide us with a measure of the adjacent tissue damage.

The Effect of the Cryosurgical Cox-Maze Procedure on Pulmonary Veins Diameter and Left Atrial Size

2009 ◽  
Vol 4 (4) ◽  
pp. 209-216
Author(s):  
Naama R. Bogot ◽  
Amir Elami ◽  
Dorith Shaham ◽  
Philip M. Berman ◽  
Jacob Sosna ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Left Atrial ◽  
Statistical Significance ◽  
Pulmonary Veins ◽  
Nonparametric Test ◽  
Maze Procedure ◽  
Pulmonary Vein Stenosis ◽  
Venous Anatomy ◽  
Lesion Pattern ◽  
Vein Stenosis

Objective The Cox-Maze procedure using cryoablation results in transmural lesions, which follow the lesion pattern of the cut-and-sew Cox-Maze procedure. The purpose of our study was to evaluate the effect of the Cox-Maze procedure on left atrial and pulmonary vein size using computed tomography angiogram (CTA). An additional aim was to evaluate pulmonary vein anatomic variability. Methods Six patients (four women and two men; ages 39–63 years, mean age 54.3) underwent chest CTA 1 day before and 38 to 104 days (mean 62.6 days) after the cryosurgical Cox-Maze procedure. Measurements of pulmonary vein ostia and left atrial cranio-caudal, left-to-right and anterior-posterior diameters were derived by consensus. The change in diameters after therapy was compared using the Wilcoxon nonparametric test for paired measurements. Four patients (1 woman and 3 men; age 57–73 years; mean age 59) were evaluated with postoperative CTA alone 296–530 days (mean 447) after surgery, for the development of postoperative pulmonary vein stenosis. A single patient underwent preoperative CTA, but surgery was not performed. Pulmonary venous anatomy was recorded in all 11 patients. Results Sinus rhythm was restored in all operated patients. No focal ostial stenosis of the pulmonary veins was observed. The quantitative assessment in the six patients with preoperative and postoperative studies disclosed only slight changes in pulmonary vein diameter with either reduction or dilatation of no more than 20% from baseline (P > 0.05). There was a consistent trend toward decrease in left atrial dimensions, which did not reach statistical significance. Six patients (55%) had standard pulmonary venous anatomy and five patients (45%) had at least one variation in their pulmonary vein anatomy. Conclusions In this study, we found that a very intensive cryoablation protocol around the pulmonary veins did not result in pulmonary vein stenosis. In addition, a relatively high incidence of anatomic variations of the pulmonary veins was documented.

Sign in / Sign up

Export Citation Format

Share Document