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Cardiovascular Images

Multimodality Imaging Assessment of Anatomic and Functional Pulmonary Vein Stenosis

Ruvin S. Gabriel, MBChB; Zoran B. Popovic, MD and Allan L. Klein, MD

From the Cleveland Clinic, Cleveland, Ohio.

Correspondence to Allan L. Klein, MD, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. E-mail kleina@ccf.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 68-year-old man with a history of permanent atrial fibrillation and symptoms of fatigue and palpitations underwent pulmonary vein ablation under intracardiac echocardiography and NAVX system 3D mapping guidance. He noticed improvement in his symptoms after the procedure and remained in sinus rhythm on follow-up arrhythmia monitoring. However, symptoms of shortness of breath and a nonproductive cough developed over 2 to 3 months. A computed tomography scan confirmed a significant stenosis of the left superior pulmonary vein. Multimodality imaging techniques were used to investigate the functional significance of the stenosis (Figure). Two-dimensional, 3D, and Doppler transesophageal echocardiography identified aliasing of color Doppler flow and spectral broadening along a long area of stenosis, demonstrating the presence of turbulent flow. The presence of turbulent flow and increased velocities on pulsed Doppler interrogation of the vein confirmed functionally significant stenosis. A tight stenosis of the left superior pulmonary vein was seen at cardiac catheterization, and successful placement of a Genesis PG1910B stent dilated to 7 mm in diameter was performed.

View larger version (103K):   Figure. A, Biplane transesophageal echocardiography of the left superior pulmonary vein at 90° perpendicular views (19° and 110°). Spectral broadening of color Doppler pulmonary venous flow identifies the presence of turbulent flow. A region of proximal flow convergence is seen at the site of maximum stenosis. B, 3D full-volume color Doppler acquisition is reconstructed to display the region of proximal flow convergence and turbulent flow. C, The presence of increased velocities on pulsed or color Doppler interrogation of pulmonary venous flow, . . . [Full Text of this Article]