Neumann Thomas, Sperzel Johannes, Dill Thorsten, Kluge Alexander, Erdogan Ali, Greis Harald, Hansel Jochen, Berkowitsch Alexander, Kurzidim Klaus, Kuniss Malte, Hamm Christian W, Pitschner Heinz-F
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
J Cardiovasc Electrophysiol. 2005 Nov;16(11):1180-8. doi: 10.1111/j.1540-8167.2005.50073.x.
Pulmonary vein stenosis (PVS) is a potential complication of pulmonary vein isolation (PVI) using radiofrequency energy. The aim of our study was the evaluation of the severity and long-term outcome of primary angioplasty and angioplasty with pulmonary vein stenting for PVS.
Twelve patients with 15 PVS (greater than 70% stenosis) were prospectively evaluated. Primary dilation of the stenosis was performed because of clinical symptoms (10 patients) and/or the lung perfusion scans showed a significant perfusion defect (11 patients). Magnetic resonance imaging and lung perfusion scans performed before, directly after, during 3-month, and 6-month follow-up. In the stenting group additional multislice CT-scans directly after, during 6-month, and 12-month follow-up were performed. Within 2 months after primary balloon angioplasty, the PV size parameters were significantly reduced (P < 0.001) with recurrence of PVS in 11 of 15 PVs (73%). Pulmonary vein stenting in 8 patients and 11 PVs resulted in no vein stenosis during 12-month follow-up. Normalization of lung perfusion was noted in 8 of 12 patients. We observed 2 patients with hemoptysis during PV dilation, as severe complications with potential life-threatening character.
PVS stenting seems to be superior to balloon angioplasty and effective at least over a period of 12 months in treating acquired PVS after pulmonary vein isolation.
肺静脉狭窄（PVS）是使用射频能量进行肺静脉隔离（PVI）的一种潜在并发症。我们研究的目的是评估原发性血管成形术以及肺静脉支架置入术治疗PVS的严重程度和长期疗效。
前瞻性评估了12例患有15处PVS（狭窄程度大于70%）的患者。因临床症状（10例患者）和/或肺灌注扫描显示明显灌注缺损（11例患者）而对狭窄进行了原发性扩张。在术前、术后即刻、3个月及6个月随访期间进行了磁共振成像和肺灌注扫描。在支架置入组，术后即刻、6个月及12个月随访期间还进行了额外的多层CT扫描。原发性球囊血管成形术后2个月内，肺静脉大小参数显著降低（P < 0.001），15处肺静脉中有11处（73%）出现PVS复发。8例患者的11处肺静脉进行了肺静脉支架置入术，在12个月的随访期间未出现静脉狭窄。12例患者中有8例肺灌注恢复正常。我们在肺静脉扩张期间观察到2例咯血患者，这是具有潜在生命危险的严重并发症。
在治疗肺静脉隔离术后获得性PVS方面，肺静脉支架置入术似乎优于球囊血管成形术，且至少在12个月内有效。
