Mattioni Giovanni, Orlandi Riccardo, Rubino Barbara, Garatti Andrea, Pastorino Ugo
Thoracic Surgery Unit, IRCCS National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, MI, Italy.
School of Thoracic Surgery, University of Milan, Via Festa del Perdono, 7, 20122 Milano, MI, Italy.
Eur Heart J Case Rep. 2024 Mar 15;8(4):ytae140. doi: 10.1093/ehjcr/ytae140. eCollection 2024 Apr.
Pulmonary vein (PV) stenosis is a rare complication after catheter ablation for atrial fibrillation (AF). While there have been reported anecdotal cases of complete PV stenosis requiring pulmonary lobectomy, only one case of pneumonectomy has been documented so far.
A 42-year-old man was referred to our Thoracic Surgery Unit for recurrent haemoptysis and exertional dyspnoea over the past 4 years and a recent finding of left PV occlusion. He suffered of relapsing AF that had almost five recurrences and that underwent a total of two percutaneous catheter ablations within a 7-year period. He also experienced a hospitalization for multifocal lobar pneumonia. Two attempts of percutaneous transluminal angioplasty (PTA) were unsuccessful. Due to the severity and the duration of PV occlusion, the previous PTA failure, the patient's age, and his symptoms, a left pneumonectomy was performed. During the postoperative period, the patient experienced only mild anaemia effectively managed with blood transfusions. Five months after surgery, he has no recurrence of symptoms.
When the PV stenosis is complete, PTA may face high failure and recurrence rates. In this setting, anatomical pulmonary resections may represent a valid option to allow symptom relief and resolution.
肺静脉（PV）狭窄是心房颤动（AF）导管消融术后一种罕见的并发症。虽然有个别病例报道了因完全性肺静脉狭窄而需要进行肺叶切除术，但迄今为止仅有一例肺切除术的记录。
一名42岁男性因过去4年反复咯血和劳力性呼吸困难以及近期发现左肺静脉闭塞，被转诊至我们的胸外科。他患有复发性房颤，几乎复发了5次，在7年期间共接受了两次经皮导管消融术。他还曾因多灶性大叶性肺炎住院治疗。两次经皮腔内血管成形术（PTA）尝试均未成功。由于肺静脉闭塞的严重程度和持续时间、之前PTA失败、患者年龄以及他的症状，实施了左肺切除术。术后期间，患者仅出现轻度贫血，通过输血有效处理。术后5个月，他的症状未复发。
当肺静脉狭窄为完全性时，PTA可能面临高失败率和复发率。在这种情况下，解剖性肺切除术可能是缓解症状的有效选择。
