Al-Bawardy Rasha, Alkashkari Wail, Althobaiti Mohammed, Kinsara Abdulhalim, Zagzoog Amin, AlQubbany Atif, Alsaiedi Abdullah
King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
JACC Case Rep. 2025 Jul 30;30(21):104408. doi: 10.1016/j.jaccas.2025.104408.
Pulmonary venous stenosis (PVS) is a rare but serious complication of atrial fibrillation pulmonary vein isolation, often diagnosed late because of vague symptoms. Stenting is a potential treatment in select cases.
A 49-year-old woman with atrial fibrillation underwent pulmonary vein isolation a year ago and presented multiple times with dyspnea and hemoptysis. She was eventually diagnosed with PVS of the left inferior pulmonary vein (LIPV) and occlusion of the left superior pulmonary vein. Invasive hemodynamics showed segmental pulmonary hypertension, with an elevated pulmonary capillary wedge pressure (PCWP) of 53 mm Hg in the affected lung vs 22 mm Hg in the unaffected side. She underwent LIPV stenting using intravascular ultrasound guidance and a drug-eluting stent. After stenting, no gradient remained across the LIPV, and the left PCWP dropped to 26 mm Hg. Hemoptysis resolved.
This case highlights segmental worse pulmonary hypertension and PCWP due to PVS, effectively treated with intravascular ultrasound-guided stenting.
肺静脉狭窄（PVS）是心房颤动肺静脉隔离术一种罕见但严重的并发症，常因症状不明确而诊断较晚。支架置入术是某些病例的一种潜在治疗方法。
一名49岁心房颤动女性患者于一年前接受了肺静脉隔离术，多次出现呼吸困难和咯血。她最终被诊断为左下肺静脉（LIPV）的PVS及左上肺静脉闭塞。有创血流动力学检查显示节段性肺动脉高压，患侧肺毛细血管楔压（PCWP）升高至53 mmHg，而未受影响侧为22 mmHg。她在血管内超声引导下使用药物洗脱支架对LIPV进行了支架置入术。支架置入术后，LIPV跨瓣压差消失，左PCWP降至26 mmHg。咯血症状消失。
本病例突出了因PVS导致的节段性更严重肺动脉高压和PCWP，血管内超声引导下支架置入术可有效治疗。
