Schneider Carsten, Ernst Sabine, Malisius Rainer, Bahlmann Edda, Lampe Friedrun, Broemel Thomas, Krause Korff, Boczor Sigrid, Antz Matthias, Kuck Karl-Heinz
Department of Cardiology, St. Georg Hospital, Lohmühlenstrasse 5, Hamburg, Germany.
J Interv Card Electrophysiol. 2007 Mar;18(2):195-205. doi: 10.1007/s10840-007-9085-1. Epub 2007 Apr 26.
Pulmonary vein stenosis (PVS) has been described as a complication after primary catheter ablation of atrial fibrillation (Afib). The purpose of this study was to evaluate the utility of transesophageal echocardiography (TEE) as follow-up tool after catheter ablation of Afib and interventional therapy of PVS and pulmonary vein occlusion (PVO).
We report on 28 patients with stenosis (PVS) of 33 pulmonary veins (PVs) and total PVO of 4 veins complicating ablation of Afib assessed by angiography and/or magnetic resonance imaging (MRI). Subsequently, transseptal PV angiograms were performed, followed by recanalization of three totally occluded PVs and balloon dilatation of seven severe PVS (in four cases combined with PV stenting). PVs were analyzed by multiplane TEE in an intraindividual comparison of preablation/preintervention and follow-up measurements of mean and peak flow velocity, velocity time integrals, and diameters.
Of a total of 28 patients, 14 had mild PVS (n = 14), 9 had moderate PVS (n = 10), 6 had severe PVS (n = 8), and 4 patients showed totally occluded PVs (n = 4). In multivariate analysis flow velocities and vessel diameters showed significant differences (mild, moderate, and severe PVS and PVO; p = 0.001). Interventional benefits of balloon dilatation (n = 10) and stent implantation (n = 4), as well as in-stent restenosis could be detected (p = 0.014). In all recanalized vessels TEE showed reestablished flow. In occluded PVs no flow was detectable. The TEE vessel diameters correlated with angiography data (r = 0.87) and computed tomography/MRI (r = 0.90).
TEE can be used as a follow-up tool after interventional therapy in patients after catheter ablation and acquired PVS/PVO. Restenosis/in-stent restenosis can be identified by analyzing the vessel diameters and blood flow characteristics.
肺静脉狭窄（PVS）已被描述为心房颤动（房颤）初次导管消融术后的一种并发症。本研究的目的是评估经食管超声心动图（TEE）作为房颤导管消融及PVS和肺静脉闭塞（PVO）介入治疗后随访工具的效用。
我们报告了28例患者，其33条肺静脉存在狭窄（PVS），4条静脉完全闭塞（PVO），这些均为房颤消融术后的并发症，通过血管造影和/或磁共振成像（MRI）进行评估。随后进行经间隔肺静脉血管造影，接着对3条完全闭塞的肺静脉进行再通，并对7条严重PVS进行球囊扩张（4例联合肺静脉支架置入）。通过多平面TEE在个体内比较消融前/介入治疗前与随访时的平均流速、峰值流速、流速时间积分和直径，对肺静脉进行分析。
28例患者中，14例为轻度PVS（n = 14），9例为中度PVS（n = 10），6例为重度PVS（n = 8），4例患者肺静脉完全闭塞（n = 4）。多因素分析显示流速和血管直径存在显著差异（轻度、中度和重度PVS及PVO；p = 0.001）。可以检测到球囊扩张（n = 10）和支架置入（n = 4）的介入治疗效果，以及支架内再狭窄（p = 0.014）。在所有再通的血管中，TEE显示血流重建。在闭塞的肺静脉中未检测到血流。TEE测量的血管直径与血管造影数据（r = 0.87）和计算机断层扫描/MRI（r = 0.90）相关。
TEE可作为导管消融及获得性PVS/PVO患者介入治疗后的随访工具。通过分析血管直径和血流特征可识别再狭窄/支架内再狭窄。
