Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Heart Rhythm. 2010 Sep;7(9):1233-9. doi: 10.1016/j.hrthm.2010.03.003. Epub 2010 Mar 3.
Pulmonary vein stenosis (PVS) complicating pulmonary vein isolation (PVI) can progress to total pulmonary vein occlusion (PVO). Little is known about the accuracy of noninvasive diagnosis and treatment of PVO.
The purpose of this study was to study the diagnostic accuracy of noninvasive testing and the feasibility and outcome of percutaneous intervention for PVO.
Computed tomography (CT)-diagnosed and angiographically confirmed PVOs were identified from percutaneous interventions for PVS complicating PVI between December 2000 and December 2008. Diagnostic accuracy of CT combined with lung perfusion scan was studied. Outcome of percutaneous intervention was reviewed.
CT diagnosed "PVO" in 53 PVs, with only 20 of 53 determined angiographically to be totally occluded. True PVO had lower perfusion (4.0%) compared with CT-diagnosed "PVO" (7.3%, P = .024). Recanalization was attempted in 9 and successful in 8. Of the 8 patients, 7 were dilated with 4.5- to 7-mm balloons and 1 was stented primarily (7 mm). At repeat catheterization 2.9 +/- 0.8 months later, 6 of 7 pulmonary veins (PVs) were stented to 5 to 10 mm. At follow-up of 11.3 +/- 8.7 months, all but 1 PV remained patent (mean diameter 6.9 +/- 1.7 mm). Flow to the lung quadrant increased from 5.6% before recanalization to 12.2% at last follow-up (P = .016). Symptoms improved in all but one patient.
PVO is overestimated by CT. Quantification of lung perfusion improves diagnostic accuracy, but angiography remains the gold standard. Recanalization of PVO can be attempted when a remnant of the PV is visible. Good mid-term patency rates and improved perfusion were observed with a two-stage approach of initial dilation and subsequent stenting. Longer follow-up and larger numbers of patients are needed to better understand when to intervene for PVO.
肺静脉狭窄（PVS）并发肺静脉隔离（PVI）可进展为完全肺静脉闭塞（PVO）。关于 PVO 的无创诊断和治疗的准确性知之甚少。
本研究旨在研究无创检查的诊断准确性，以及经皮介入治疗 PVO 的可行性和结果。
从 2000 年 12 月至 2008 年 12 月期间因 PVS 并发 PVI 而行经皮介入治疗的患者中，确定了 CT 诊断和血管造影证实的 PVO。研究了 CT 结合肺灌注扫描的诊断准确性。回顾了经皮介入治疗的结果。
CT 诊断 53 条肺静脉中有“PVO”，其中仅 20 条血管造影显示完全闭塞。真正的 PVO 的灌注量（4.0%）低于 CT 诊断的“PVO”（7.3%，P=0.024）。尝试对 9 条进行再通，其中 8 条成功。在 8 例患者中，7 例采用 4.5-7mm 球囊扩张，1 例直接支架（7mm）。2.9±0.8 个月后重复导管检查时，7 条肺静脉（PV）中有 6 条支架扩张至 5-10mm。随访 11.3±8.7 个月时，除 1 条肺静脉外，所有肺静脉均保持通畅（平均直径 6.9±1.7mm）。再通后肺象限的血流量从再通前的 5.6%增加到最后随访时的 12.2%（P=0.016）。除 1 例患者外，所有患者的症状均有所改善。
CT 高估了 PVO。肺灌注的定量分析可提高诊断准确性，但血管造影仍是金标准。当可见残留的肺静脉时，可尝试再通 PVO。采用初始扩张和随后支架置入的两阶段方法，可获得良好的中期通畅率和改善的灌注。需要更长时间的随访和更多的患者，以便更好地了解何时对 PVO 进行干预。
