Lu Hai-Wen, Wei Ping, Jiang Sen, Gu Shu-Yi, Fan Li-Chao, Liang Shuo, Ji Xiaobin, Rajbanshi Bhavana, Xu Jin-Fu
From the Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2015 Aug;94(34):e1346. doi: 10.1097/MD.0000000000001346.
The aim of this study is to characterize the clinical manifestations and features of pulmonary vein stenosis (PVS) by retrospectively analyzing clinical data of patients in addition to reviewing the literature simultaneously to improve the understanding of PVS complicating radiofrequency catheter ablation and to provide evidence for early diagnosis and timely treatment.Clinical, imaging, and follow-up data of 5 patients with PVS-complicating radiofrequency catheter ablation were retrospectively analyzed between January 2012 and December 2014 in Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Relevant studies previously reported were also reviewed.Three out of 5 patients received pulmonary angiography. The initial symptoms were not specific, presenting chest pain in 3 cases, hemoptysis in 2 cases. The average duration between radiofrequency ablation to the onset of symptoms was 5.8 months. The chest image results were consolidation and pleural effusion mainly. Veins distributed in the left lungs were mostly influenced in 4 patients, and the inferior veins in 3 patients. Cardiac ultrasound examinations showed pulmonary arterial hypertension in 2 patients. Two patients received selective bronchial artery embolization after bronchial artery radiography because of hemoptysis. One patient underwent video-assisted thoracoscopic biopsy because of the suspicion of tumor.PVS is a condition mostly undetected because of its silent manifestations and inconsistent follow-up. The accurate clinical diagnosis is very difficult. A careful review of medical history and follow-up observation may be useful for all the patients who received the radiofrequency catheter ablation to recognize PVS in the early stage.
本研究旨在通过回顾性分析患者的临床资料并同时复习文献，以描述肺静脉狭窄（PVS）的临床表现和特征，从而提高对PVS并发射频导管消融的认识，并为早期诊断和及时治疗提供依据。2012年1月至2014年12月期间，在中国上海同济大学医学院附属上海市肺科医院，对5例并发PVS的射频导管消融患者的临床、影像和随访资料进行了回顾性分析。还复习了先前报道的相关研究。5例患者中有3例接受了肺血管造影。初始症状不具特异性，3例出现胸痛，2例出现咯血。从射频消融到症状出现的平均时间为5.8个月。胸部影像结果主要为实变和胸腔积液。4例患者左肺分布的静脉受影响最常见，3例患者下肺静脉受影响。心脏超声检查显示2例患者有肺动脉高压。2例患者因咯血在支气管动脉造影后接受了选择性支气管动脉栓塞。1例患者因怀疑肿瘤接受了电视辅助胸腔镜活检。由于PVS临床表现隐匿且随访不一致，大多未被发现。准确的临床诊断非常困难。仔细回顾病史并进行随访观察，可能有助于所有接受射频导管消融的患者早期识别PVS。
