Korean J Radiol.  2012 Dec;13(6):816-819. 10.3348/kjr.2012.13.6.816.

Hemodynamic Change in Pulmonary Vein Stenosis after Radiofrequency Ablation: Assessment with Magnetic Resonance Angiography

• Yun D
• Jung JI
• Oh YS
• Youn HJ

• KMID: 1397515
• DOI: http://doi.org/10.3348/kjr.2012.13.6.816

Abstract

We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.

Keyword

Pulmonary vein; Radiofrequency catheter ablation; Complication; Hemodynamics; Magnetic resonance angiography

MeSH Terms

Atrial Fibrillation/*surgery
Blood Flow Velocity
Catheter Ablation/*adverse effects
Constriction, Pathologic/*etiology/pathology
Contrast Media
Humans
*Magnetic Resonance Angiography
Male
Middle Aged
Pulmonary Artery/pathology/physiopathology
*Pulmonary Circulation
Pulmonary Veins/*pathology/physiopathology

Figure

• 

  Fig. 1 Pulmonary vein stenosis after radiofrequency ablation in a 48-year-old man. A. Chest CT with mediastinal setting shows ill-defined soft tissue infiltrations in right mediastinum encases bronchovascular bundle. Right superior pulmonary vein is faintly opacified and disconnected (thick arrows), and right inferior pulmonary vein is obstructed (thin arrow). B. Lung perfusion scan with Tc-99m MAA shows absence of right lung perfusion. C. Coronal MIP images from 3D time-resolved MR angiography (TR/TE = 2.7/1.0 ms, flip angle = 19°), with sample interval of 1 second, shows later opacification of right pulmonary artery, relative to left pulmonary artery. Note early opacification of right chest wall vein (arrows), and connection between pulmonary artery and systemic arteries (arrowheads). MIP = maximum intensity projection. D. Time-flow volume curves show reversed flow direction of right pulmonary artery (RPA) in diastolic phase and continuous diastolic forward flow in left pulmonary artery (LPA).

Reference

1. Latson LA, Prieto LR. Congenital and acquired pulmonary vein stenosis. Circulation. 2007. 115:103–108.

2. Saad EB, Marrouche NF, Saad CP, Ha E, Bash D, White RD, et al. Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. Ann Intern Med. 2003. 138:634–638.

3. Griffin M, Grist TM, François CJ. Dynamic four-dimensional MR angiography of the chest and abdomen. Magn Reson Imaging Clin N Am. 2009. 17:77–90.

4. Lohan DG, Krishnam M, Tomasian A, Saleh R, Finn JP. Time-resolved MR angiography of the thorax. Magn Reson Imaging Clin N Am. 2008. 16:235–248. viii

5. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998. 339:659–666.

6. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010. 3:32–38.

7. Kluge A, Dill T, Ekinci O, Hansel J, Hamm C, Pitschner HF, et al. Decreased pulmonary perfusion in pulmonary vein stenosis after radiofrequency ablation: assessment with dynamic magnetic resonance perfusion imaging. Chest. 2004. 126:428–437.

8. Heyneman LE, Nolan RL, Harrison JK, McAdams HP. Congenital unilateral pulmonary vein atresia: radiologic findings in three adult patients. AJR Am J Roentgenol. 2001. 177:681–685.

9. Roman KS, Kellenberger CJ, Macgowan CK, Coles J, Redington AN, Benson LN, et al. How is pulmonary arterial blood flow affected by pulmonary venous obstruction in children? A phase-contrast magnetic resonance study. Pediatr Radiol. 2005. 35:580–586.