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(Circulation. 2002;106:968.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Ultrasonic Characterization of the Pulmonary Venous Wall

Echographic and Histological Correlation

José Angel Cabrera, MD, PhD; Damián Sánchez-Quintana, MD, PhD; Jerónimo Farré, MD, PhD, FESC; Felipe Navarro, MD; José Manuel Rubio, MD; Fernando Cabestrero, MD; Robert H. Anderson, MD, FRCPath; Siew Yen Ho, PhD, FRCPath

From Servicio de Cardiología (J.A.C., J.F., F.N., J.M.R., F.C.), Fundación Jiménez Díaz, Universidad Autónoma, Madrid; Departamento de Anatomía Humana (D.S.Q.), Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain; Cardiac Unit (R.H.A.), Institute of Child Health, University College London; and Paediatrics (S.Y.H.), National Heart and Lung Institute, Imperial College, London, UK.

Correspondence to Siew Yen Ho, Paediatrics, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK. E-mail yen.ho{at}ic.ac.uk

Background— Pulmonary vein isolation with radiofrequency catheter ablation techniques is used to prevent recurrences of human atrial fibrillation. Visualization of the architecture at the venoatrial junction could be crucial for these ablative techniques. Our study assesses the potential for intravascular ultrasound to provide this information.

Methods and Results— We retrieved 32 pulmonary veins from 8 patients dying from noncardiac causes. We obtained cross-sectional intravascular ultrasound (IVUS) images with a 3.2F, 30-MHz ultrasound catheter at intervals on each vein. Histological cross-sections at the intervals allowed comparisons with ultrasonic images. The pulmonary venous wall at the venoatrial junction revealed a 3-layered ultrasonic pattern. The inner echogenic layer represents both endothelium and connective tissue of the media (mean maximal thickness, 1.4±0.3 mm). The middle hypoechogenic stratum corresponds to the sleeves of left atrial myocardium surrounding the external aspect of the venous media. This layer was thickest at the venoatrial junction (mean maximal thickness, 2.6±0.8 mm) and decreased toward the lung hilum. The outer echodense layer corresponds to fibro-fatty adventitial tissue (mean maximal thickness, 2.15±0.36 mm). We found a close agreement among the IVUS and histological measurements for maximal luminal diameter (mean difference, -0.12±1.3 mm) and maximal muscular thickness (mean difference, 0.17±0.13 mm) using the Bland and Altman method.

Conclusions— Our experimental study demonstrates for the first time that IVUS images of the pulmonary veins can provide information on the distal limits and thickness of the myocardial sleeves and can be a valuable tool to help accurate targeting during ablative procedures.

Key Words: atrial flutter • ablation • imaging • arrhythmia • electrophysiology

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