Ahero Anete, Frauenfelder Thomas, Breitenstein Alexander, Ammann Peter, Kucher Nils, Barco Stefano
Clinic for Internal Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland.
Institute for Diagnostic and Interventional Radiology, Raemistrasse 100, 8091 Zürich, Switzerland.
Eur Heart J Case Rep. 2023 Feb 2;7(2):ytad057. doi: 10.1093/ehjcr/ytad057. eCollection 2023 Feb.
The use of pulmonary vein (PV) radiofrequency ablation for atrial fibrillation (AF) treatment may be complicated by PV stenosis or occlusion. A common curative treatment for symptomatic patients is a transcatheter intervention, including percutaneous transluminal balloon angioplasty and stent implantation. Stent implantation itself, however, can be complicated by in-stent stenosis.
A 26-year-old man presented with worsening exertional dyspnoea due to a total occlusion of both left PVs after the isolation of two PVs for AF. Chest computed tomography (CT) showed chest asymmetry and consolidation of the left lung. The patient was treated with balloon angioplasty and stent placement of both left PVs, resulting in improvement of symptoms, walking distance, and increase in lung space volume by 120 mL based on CT-based volumetry. Ten months later, the patient experienced a recurrence of similar symptoms. A high grade in stent restenosis of the upper left PV and moderate in stent restenosis of the lower PV were diagnosed and treated with angioplasty. The patient was discharged from the hospital in good clinical condition 3 days after the intervention.
Non-specific symptoms of PV stenosis or occlusion, such as shortness of breath, fatigue, flu-like symptoms, reduced physical performance, and haemoptysis delay the diagnosis. If unusual symptoms appear abruptly after PV isolation, a PV stenosis should be considered. In this case, we describe for the first time a partially reversible consolidation of lung parenchyma following the revascularization of both PVs.
采用肺静脉（PV）射频消融治疗心房颤动（AF）可能并发PV狭窄或闭塞。对于有症状的患者，常见的治疗方法是经导管介入治疗，包括经皮腔内球囊血管成形术和支架植入术。然而，支架植入本身可能并发支架内狭窄。
一名26岁男性，因AF行两个PV隔离术后出现左PV完全闭塞，导致劳力性呼吸困难加重。胸部计算机断层扫描（CT）显示胸部不对称及左肺实变。该患者接受了左PV球囊血管成形术和支架置入术，症状改善，步行距离增加，基于CT容积测量法，肺容积增加120 mL。10个月后，患者再次出现类似症状。诊断为左上PV支架内高度再狭窄及左下PV支架内中度再狭窄，并接受血管成形术治疗。干预3天后患者临床状况良好出院。
PV狭窄或闭塞的非特异性症状，如呼吸急促、疲劳、流感样症状、体力下降和咯血，会延迟诊断。如果PV隔离后突然出现异常症状，应考虑PV狭窄。在本病例中，我们首次描述了PV再血管化后肺实质部分可逆性实变。
