Qureshi Athar M, Prieto Lourdes R, Latson Larry A, Lane Geoffrey K, Mesia C Igor, Radvansky Penelope, White Richard D, Marrouche Nassir F, Saad Eduardo B, Bash Dianna L, Natale Andrea, Rhodes John F
Department of Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Circulation. 2003 Sep 16;108(11):1336-42. doi: 10.1161/01.CIR.0000086322.21781.6A. Epub 2003 Sep 2.
Pulmonary vein stenosis has recently been recognized as a complication of radiofrequency ablation for atrial fibrillation. This study evaluates the presentation of affected patients and the role of transcatheter therapy for this patient population.
This study used a retrospective review of data from 19 patients (age, 51+/-13 years) with pulmonary vein stenosis who underwent catheterization and angiography between December 2000 and December 2002. Quantitative perfusion and spiral CT scans were performed for initial diagnosis and follow-up. The median duration between radiofrequency ablation and the reported onset of respiratory symptoms for 18 of 19 patients was 7.5 weeks (0.1 to 48). After the onset of symptoms, all but two patients were initially misdiagnosed with a symptoms-to-diagnosis duration of 16 weeks (2-59). At initial catheterization, 17 of 19 patients had angioplasty in 30 veins with stent placement in 5 vessels when a flap occurred. Overall vessel diameter increased from 2.6+/-1.6 to 6.6+/-2.4 mm (P<0.0001). There were 4 procedure-related adverse events but no long-term sequelae. Immediate follow-up showed improved flow to involved lung segments. At a median follow-up of 43 weeks (2-92), although repeat angioplasty for restenosis was necessary in 8 of 17 patients, 15 of 17 patients currently have no or minimal persistent symptoms.
Pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation is often misdiagnosed. Although further follow-up is necessary to determine long-term success, our data indicate better pulmonary vein flow and symptomatic improvement in the majority of patients undergoing dilation of postablation pulmonary vein stenosis.
肺静脉狭窄近来被认为是心房颤动射频消融的一种并发症。本研究评估了受影响患者的表现以及经导管治疗对该患者群体的作用。
本研究回顾性分析了2000年12月至2002年12月期间19例（年龄51±13岁）肺静脉狭窄患者的数据，这些患者接受了心导管插入术和血管造影。进行了定量灌注和螺旋CT扫描用于初始诊断和随访。19例患者中有18例在射频消融与报告的呼吸道症状发作之间的中位持续时间为7.5周（0.1至48周）。症状发作后，除2例患者外，所有患者最初均被误诊，症状至诊断的持续时间为16周（2至59周）。在初始心导管插入术时，19例患者中有17例对30条静脉进行了血管成形术，并在出现瓣叶时对5条血管进行了支架置入。总体血管直径从2.6±1.6毫米增加到6.6±2.4毫米（P<0.0001）。有4例与手术相关的不良事件，但无长期后遗症。即时随访显示受累肺段血流改善。在中位随访43周（2至92周）时，尽管17例患者中有8例因再狭窄需要重复血管成形术，但1
