Percutaneous Pulmonary Vein Stenting to Treat Severe Pulmonary Vein Stenosis After Surgical Reconstruction

A 36-year-old female underwent left lower lobectomy with left atrial and left upper pulmonary vein (LUPV) reconstruction with a bovine pericardial patch for an intrathoracic pheochromocytoma. Postoperatively, she developed shortness of breath and transesophageal echocardiography demonstrated LUPV stenosis with increased velocities. Computed tomography angiogram of the chest revealed LUPV stenosis at the left atrium ostium with an area of 39 mm2. Under angiographic and echocardiographic guidance, a 10 × 19 mm Omnilink Elite uncovered stent was deployed in the LUPV ostia. While reported following left atrial ablation, pulmonary vein stenting can be successful in a pulmonary vein surgically reconstructed with bovine pericardium.

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Abstract 14990: Pulmonary Vein Stenosis After Epicardial Atrial Fibrillation Ablation and Epicardial Left Atrial Appendage Occlusion: A Diagnostic Dilemma and Challenges in Management

Circulation ◽

10.1161/circ.142.suppl_3.14990 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Moghniuddin Mohammed ◽

Nachiket Apte ◽

Mohammed Ansari ◽

Amit Noheria ◽

Seth Sheldon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Maze Procedure ◽

Pulmonary Vein Stenosis ◽

Epicardial Ablation ◽

Left Atrial Appendage Occlusion ◽

Vein Stenosis

Background: Pulmonary vein stenosis is a dreaded complication of endocardial atrial fibrillation (AF) ablation but rare after epicardial ablation and has not been reported after epicardial left atrial appendage occlusion (LAAO). Case: A 55-year-old male was referred to our tertiary hospital for management of left superior pulmonary vein (LSPV) stenosis causing dyspnea on exertion. About 2 years prior to presentation, he underwent quadruple coronary artery bypass grafting for non-ST elevation myocardial infarction along with modified Cox-Maze procedure with pulmonary vein and posterior wall isolation as well as epicardial LAAO with AtriClip for history of paroxysmal AF. At our institute, V/Q scan showed ventilation-perfusion mismatch and absent perfusion of the left upper lobe (Figure 1A). Cardiac CT showed persistent LSPV occlusion (Figure 1B). TEE showed atrial appendage occluded with a clip and no flow was observed from LSPV (Figure 1C). After multidisciplinary discussion between cardiology and cardiothoracic surgery teams, surgical approach to remove the AtriClip was deemed futile as it was placed 2 years ago and less likely to result in resolution of stenosis. Thus, an endovascular approach was attempted with left atrial and pulmonary vein angiography showing LSPV to be 100% occluded (Figure 1D). Pulmonary vein recanalization was attempted but was not successful. Conclusion: Our case highlights the importance of recognition of PVS as a possible complication after epicardial LAAO as early intervention can improve patient outcomes. PVS has been previously described with Maze procedure but that patient was successfully treated with catheter-balloon angioplasty. Given 100% occlusion and difficulty with recanalization makes epicardial ablation a less likely cause of occlusion in our case. More careful application of Atriclip protocols might be necessary to prevent this potential complication.

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Modified sutureless repair using left atrial appendage flap for acquired left-sided pulmonary vein stenosis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa032 ◽

2020 ◽

Vol 58 (2) ◽

pp. 395-397

Author(s):

Hideki Ito ◽

Masato Mutsuga ◽

Yoshiyuki Tokuda ◽

Akihiko Usui

Keyword(s):

Catheter Ablation ◽

Pulmonary Vein ◽

Left Atrial ◽

Radiofrequency Catheter Ablation ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Successful Outcome ◽

Pulmonary Vein Stenosis ◽

Sutureless Technique ◽

Vein Stenosis

Abstract Pulmonary vein stenosis is a well-known complication after radiofrequency catheter ablation of atrial fibrillation. Although surgical repair is indicated for younger patients and patients with multiple stenoses, the appropriate procedure for acquired pulmonary vein stenosis has not been established. In this study, we report the successful outcome of our modified sutureless technique using a left atrial appendage flap for left-sided pulmonary vein stenosis after radiofrequency catheter ablation.

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Combined pulmonary vein stenosis stenting and left atrial appendage occlusion in a patient with hemoptysis after atrial fibrillation ablation

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01483-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yan-Jie Li ◽

Xin Pan ◽

Cheng Wang ◽

Ben He

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Fibrillation Ablation ◽

Atrial Appendage ◽

Pulmonary Vein Stenosis ◽

Left Atrial Appendage Occlusion ◽

Vein Stenosis

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Severe Pulmonary Vein Stenosis and Extensive Left Atrial Stricture After Radiofrequency Catheter Ablation of Atrial Fibrillation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.12662 ◽

2015 ◽

Vol 26 (10) ◽

pp. 1151-1152 ◽

Cited By ~ 2

Author(s):

CHANG HEE KWON ◽

SEUNG-WHAN LEE ◽

JONG-YOUNG LEE ◽

GI-BYOUNG NAM

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Left Atrial ◽

Radiofrequency Catheter Ablation ◽

Pulmonary Vein Stenosis ◽

Vein Stenosis

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181b0aad9 ◽

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.

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Rare combination of bilateral divided atrial chambers and pulmonary vein stenosis with review of the literature

Cardiology in the Young ◽

10.1017/s1047951114001073 ◽

2014 ◽

Vol 25 (2) ◽

pp. 218-221 ◽

Cited By ~ 3

Author(s):

Faris Al-Mousily ◽

Ghassan Baslaim ◽

Amjad Kouatli ◽

Jameel Al-Ata ◽

Amin M. Arfi

Keyword(s):

Pulmonary Vein ◽

Left Atrial ◽

Right Atrial ◽

Cor Triatriatum ◽

Pulmonary Vein Stenosis ◽

Review Of The Literature ◽

Autopsy Study ◽

Cor Triatriatum Sinister ◽

Cor Triatriatum Dexter ◽

Vein Stenosis

AbstractIntroduction:The term cor triatriatum is used to describe a fibromuscular partition that divides an atrium into two compartments. It was first used by Borst in 1905, although the lesion had been described before by Church in 1868. Both described divided left atrial chamber (also referred to as cor triatriatum sinister). The incidence of the divided left atrial chamber among patients with congenital heart disease is reported at 0.1% and 0.4% in an autopsy study. Divided right atrial chamber – also referred to as cor triatriatum dexter – is even rarer to an extent that there is no reported incidence and only few hundred cases have been reported so far. A search through pubMed library revealed only 90 publications on humans, either under the term “dexter” or “dextrum”. We would like to report a new association of bilateral divided atrial chambers and pulmonary vein stenosis, with a review of the literature.

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