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Strategies on How to Diagnose, Prevent, and Treat Pulmonary Vein Stenosis

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Atrial Fibrillation

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Imaging strategies used to facilitate catheter ablation for atrial fibrillation (AF) have provided a deeper understanding of the anatomy of the pulmonary veins (PVs). Pulmonary vein stenosis (PVS) is a possible complication of AF ablation and can present either asymptomatically or symptomatically. Symptoms such as dyspnea, cough, hemoptysis, chest pain, or the generalized appearance of bronchitis or pneumonia can be present in clinically relevant PVS. Magnetic resonance imaging and computed tomography are the best imaging strategies for establishing the presence and severity of PVS. Ventilation/profusion nuclear scanning can provide insight into the physiology of blood flow within the stenosed PV. Intervention for PVS is indicated in patients with significant symptoms or progressive stenosis in more than one vein and in patients with more than 85% to 95% stenosis in the absence of symptoms. Risks of pulmonary vein dilation include infection, bruising, pain, hematoma, deep vein thrombosis, pulmonary embolism, or peripheral artery damage. When stenosed vessels are appropriately dilated, the lesions typically decrease from the prestenosis level down to 0% to 20%. However, follow-up studies have shown a high rate of instent and insegment restenosis, and because of the unavailability of coated stents 10 mm or larger in diameter, stenting on the first procedure is not currently recommended or practiced in large centers undertaking frequent interventional vein dilation procedures. Patients must be aware that two or three procedures could be required to complete the dilation process with or without stenting. Long-term follow-up studies have shown that extensive collateralization of vessels over time can be a chief factor in reducing symptoms. A careful assessment of the risk of the procedure must be weighed against the potential likelihood of success prior to intervention.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MI, USA

    Douglas L. Packer (Professor of Medicine, Director, Heart Rhythm Services)

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  1. Douglas L. Packer
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Editors and Affiliations

  1. Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA

    Andrea Natale MD (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor) (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor)

  2. Division of Cardiology, Stanford University, Palo Alto, CA, USA

    Andrea Natale MD (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor) (Executive Medical Director of the Texas Cardiac Arrhythmia Institute, Consulting Professor)

  3. University of Michigan, Ann Arbor, MI, USA

    José Jalife MD (Professor of Internal Medicine, The Cyrus and Jane Farrehi Professor of Cardiovascular Research, Professor of Molecular and Integrative Physiology) (Professor of Internal Medicine, The Cyrus and Jane Farrehi Professor of Cardiovascular Research, Professor of Molecular and Integrative Physiology)

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© 2008 Humana Press, a part of Springer Science+Business Media, LLC

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Packer, D.L. (2008). Strategies on How to Diagnose, Prevent, and Treat Pulmonary Vein Stenosis. In: Natale, A., Jalife, J. (eds) Atrial Fibrillation. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-163-5_21

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  • DOI: https://doi.org/10.1007/978-1-59745-163-5_21

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-856-0

  • Online ISBN: 978-1-59745-163-5

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