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      Cardiopulmonary hemodynamic clues for pulmonary vein stenosis diagnosis

      case-report

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          Abstract

          Pulmonary vein stenosis (PVS) post radiofrequency ablation for chronic atrial fibrillation poses a diagnostic challenge for the clinician. PVS presents with nonspecific symptoms, signs and radiographic features, and may be associated with significant pulmonary vascular involvement. Interestingly, others have described variation of the pulmonary artery wedge pressure between sites of the lung as a clue to pulmonary veno-occlusive disorders. We report, to the best of our knowledge, the first case that describes the regional loss of V waves while recording the mean pulmonary artery wedge pressure (mPawp) as well as the difference in pulmonary artery wedge pressure gradients as the main diagnostic clues for PVS.

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          Pulmonary vein stenosis after catheter ablation of atrial fibrillation.

          John Doyle, Denis G. Kay, James E Loyd … (1998)
          This report describes the complication of pulmonary vein stenosis with resultant severe pulmonary hypertension that developed in 2 patients after successful catheter ablation of chronic atrial fibrillation. Three months after successful catheter ablation of atrial fibrillation, both patients developed progressive dyspnea and pulmonary hypertension. Both were found to have severe stenosis of all 4 pulmonary veins near the junction with the left atrium. Balloon dilation of the stenotic pulmonary veins was performed in these patients, with improvement in dyspnea and pulmonary hypertension. The complication of pulmonary vein stenosis is potentially life-threatening, and the application of radiofrequency current within the pulmonary veins with standard catheter technology should be avoided. This complication can be treated with balloon dilation, although the long-term course is unknown.
          Article 0 comments Cited 44 times – based on 0 reviews     Review now
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            Total pulmonary vein occlusion as a consequence of catheter ablation for atrial fibrillation mimicking primary lung disease.

            Madelon M. E. Riem, Masahiko Goya, Sabine Ernst … (2003)
            Catheter ablation has recently been used for curative treatment of atrial fibrillation. Three of 239 patients who underwent ablation close to the pulmonary vein (PV) ostia at our institute developed severe hemoptysis, dyspnea, and pneumonia as early as 1 week and as late as 6 months after the ablation. Because the patients were arrhythmia-free, the treating physician initially attributed the symptoms to new-onset pulmonary disease (e.g., bronchopulmonary neoplasm). After absent PV flow was confirmed by transesophageal echocardiography, transseptal contrast injection depicted a totally occluded PV in all three patients. Successful recanalization, even in chronically occluded Pvs, was performed in all patients. During follow-up, Doppler flow measurements by transesophageal echocardiography demonstrated restenosis in all primarily dilated PV, which led to stent implantation. PV stenosis/occlusion after catheter ablation of atrial fibrillation occurs in a subset of patients. However, because in-stent restenosis occurred in two patients after 6 to 10 weeks, final interventional strategy for PV stenosis or occlusion remains unclear. To prevent future PV stenosis or occlusion, a decrease in target temperature and energy of radiofrequency current or the use of new energy sources (ultrasound, cryothermia, microwave) seems necessary.
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              Beyond the wedge: clinical physiology and the Swan-Ganz catheter.

              Scott W Sharkey (1987)
              The Swan-Ganz catheter was introduced into general clinical medicine in 1970 and quickly gained widespread use in the management of critically ill patients. The device offers highly sophisticated physiologic information; however, in many instances, only the wedge pressure and the cardiac output are utilized when managing acutely ill patients. The purpose of this review is to illustrate and explain the array of physiologic data available from the Swan-Ganz catheter in most circumstances. A basic understanding of the information that can be obtained with the Swan-Ganz catheter is quite useful in the diagnosis and management of a variety of cardiovascular disorders. In addition, the Swan-Ganz catheter can be a helpful tool for teaching cardiovascular pathophysiology.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pulm Circ
                Journal ID (iso-abbrev): Pulm Circ
                Journal ID (publisher-id): PC
                Title: Pulmonary Circulation
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2045-8932
                ISSN (Electronic): 2045-8940
                Publication date (Print): Oct-Dec 2011
                Volume: 1
                Issue: 4
                Pages: 499-500
                Affiliations
                [1 ]Department of Internal Medicine, Division of Hospital Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
                [2 ]Department of Internal Medicine, Division of Hospital Medicine, McKay Dee Regional Hospital, Ogden, UT, USA
                [3 ]Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah School of Medicine, Salt Lake City, UT, USA
                Author notes
                Address correspondence to: Dr. Mateo Porres-Aguilar, Department of Internal Medicine, Division of Hospital Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA. E-mail: mateo.porres@ 123456ttuhsc.edu
                Article
                Publisher ID: PC-1-499
                DOI: 10.4103/2045-8932.93549
                PMC ID: 3329080
                PubMed ID: 22530105
                SO-VID: 11644389-02b2-4683-9c0f-57dcd35f1a9d
                Copyright © Copyright: © Pulmonary Circulation
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Keywords: atrial fibrillation,radiofrequency ablation,pulmonary vein stenosis,pulmonary hypertension
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: atrial fibrillation, radiofrequency ablation, pulmonary vein stenosis, pulmonary hypertension

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