Schneider Carsten, Ernst Sabine, Bahlmann Edda, Malisius Rainer, Krumsdorf Ulrike, Boczor Sigrid, Lampe Friedrun, Hoffmann-Riem Martin, Kuck Karl-Heinz, Antz Matthias
Department of Cardiology, AK St. Georg General Hospital, II. Med. Abteilung (Kardiologie), Lohmühlenstrasse 5, 20099 Hamburg, Germany.
Eur J Echocardiogr. 2006 Dec;7(6):447-56. doi: 10.1016/j.euje.2006.03.008. Epub 2006 May 11.
Pulmonary vein (PV) stenosis has been described as a complication after catheter ablation of atrial fibrillation. The aim of the study was to investigate the diagnostic role of transesophageal echocardiography (TEE) in the assessment of PV stenosis.
Ninety-one patients (71 men, mean age 57+/-16years), initially treated by catheter ablation of atrial fibrillation, underwent re-ablation because of arrhythmia recurrences. PV angiograms and TEE were performed before the first and second ablation. PVs were analysed in an intraindividual comparison by measurements of mean and peak flow velocity and of velocity time integrals and diameters. PV angiograms served as standard for assessment of PV stenosis.
Sixteen of 91 patients developed PV stenoses as a consequence of the first ablation (13 mild PV stenoses, 4 moderate PV stenoses). All patients with PV stenosis were asymptomatic. In moderate PV stenosis (50-70%) a significant increase of blood flow parameters, reduction of vessel diameter, inhomogeneous blood flow and aliasing were demonstrated by TEE. Using quantitative TEE criteria moderate PV stenosis could be identified with a sensitivity of 84% and specificity of 98%. Detection of mild PV stenosis (30-50%) is challenging (sensitivity of 48% and specificity of 75%).
TEE identifies significant PV stenosis by assessment of flow characteristics and vessel diameter and can thereby be used as a follow-up tool after catheter ablation of atrial fibrillation.
肺静脉（PV）狭窄已被描述为心房颤动导管消融术后的一种并发症。本研究的目的是探讨经食管超声心动图（TEE）在评估PV狭窄中的诊断作用。
91例患者（71例男性，平均年龄57±16岁）最初接受心房颤动导管消融治疗，因心律失常复发而接受再次消融。在第一次和第二次消融前进行PV血管造影和TEE检查。通过测量平均流速、峰值流速、流速时间积分和直径，对个体内的PV进行比较分析。PV血管造影作为评估PV狭窄的标准。
91例患者中有16例因首次消融出现PV狭窄（13例轻度PV狭窄，4例中度PV狭窄）。所有PV狭窄患者均无症状。在中度PV狭窄（50-70%）时，TEE显示血流参数显著增加、血管直径减小、血流不均匀和血流信号混叠。采用定量TEE标准，中度PV狭窄的识别灵敏度为84%，特异度为98%。轻度PV狭窄（30-50%）的检测具有挑战性（灵敏度为48%，特异度为75%）。
TEE通过评估血流特征和血管直径来识别显著的PV狭窄，因此可作为心房颤动导管消融术后的随访工具。
