Circulation. 2003;107:e129-e130
doi: 10.1161/01.CIR.0000062744.33841.EF
(Circulation. 2003;107:e129.)
© 2003 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation
Image Findings With Multiphasic Pulmonary Magnetic Resonance Angiography
Christian Fink, MD;
Astrid Schmaehl, MD;
Michael Bock, PhD;
Siegfried Tuengerthal, MD;
Stefan Delorme, MD
From the Deutsches Krebsforschungszentrum (dkfz), Department of Radiology (C.F., S.D.) and Biophysics and Medical Radiation Physics (M.B.) and Thoraxklinik Heidelberg, Department of Radiology (A.S., S.T.), Heidelberg, Germany.
Correspondence to Dr Christian Fink, Deutsches Krebsforschungszentrum, FS Radiologische Diagnostik, E0100, Im Neuenheimer Feld 280, 69115 Heidelberg, Germany. E-mail c.fink{at}dkfz.de
A 53-year-old man was admitted with productive cough, chest pain, and hemoptysis. Eight months earlier, he had undergone radiofrequency ablation for atrial fibrillation originating from the right upper and both left pulmonary veins. Computed tomography demonstrated bronchopneumonic infiltrates in both upper lobes (Figure 1). A perfusion scintigram, performed to exclude pulmonary embolism, showed hypoperfusion of both upper lobes, despite a normal ventilation scintigram (Figure 2). Catheter angiography showed hypoperfusion of the upper lobes and no pathology of the pulmonary arteries (Figure 3). In the venous phase, both upper pulmonary veins were not visible (Figure 4). To achieve discrimination of the arterial and venous lung vessels, a time-resolved multiphasic pulmonary magnetic resonance angiography (MRA) was performed. Despite a lower spatial resolution, MRA was able to visualize both upper pulmonary veins with high-grade stenoses. On the basis of these findings, recanalization therapy of the pulmonary veins was planned.
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Figure 1. A and B, Computed tomography scan showing bronchopneumonic infiltrates in both upper lobes. C and D, T1-weighted transversal MRI similarly demonstrates the bronchopneumonic infiltration of the upper lobes.
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Figure 2. Perfusion scintigram showing hypoperfusion of both upper lobes. The hypoperfusion is more pronounced on the right side.
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Figure 3. Arterial hypoperfusion of both upper lobes demonstrated by (A) selective catheter angiography and (B) pure arteriogram obtained from noninvasive multiphasic MRA.
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Figure 4. A, Venous phase of conventional catheter angiography. Both upper pulmonary veins are not visualized (arrows). B, Targeted maximum intensity projections of the MRA visualize both upper pulmonary veins (arrowheads) and reveal high-grade stenoses of both veins (arrows). C and D, Both lower pulmonary veins (arrows) are free of pathology.
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Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
