Pulmonary Vein Stenosis and Pulmonary Hypertension Following a Catheter-Based Radiofrequency Ablation for Atrial Fibrillation: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents
Christopher A. Thomas, Karla J. Cruz Morel, Mohan N. Viswanathan, Vinicio A. de Jesus Perez
Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
Am J Case Rep 2020; 21:e924709
Available online: 2020-07-15
Pulmonary vein (PV) stenosis is a rare condition characterized by progressive luminal size reduction of one or more pulmonary veins (PVs), which can increase postcapillary pressure resulting in shortness of breath, cough, hemoptysis, and pulmonary hypertension (PH). The diagnosis of PV stenosis requires a high degree of suspicion. PV stenosis is a rare but recognized complication of catheter-based radiofrequency ablation (RFA) for atrial fibrillation (AF).
CASE REPORT: We present a case of a 78-year-old man who underwent a surgical MAZE procedure followed by catheter-based RFA to treat AF. He subsequently developed shortness of breath, exercise limitation, and PH. The patient was ultimately diagnosed with PV stenosis, which was a sequela of the RFA and the cause of his PH. The patient was treated by stenting of his PV, with improvement in his exercise capacity and PH. Follow-up imaging showed improved pulmonary blood flow and reduced pulmonary pressures.
CONCLUSIONS: We conclude that PV stenosis should be high in the differential as the cause of dyspnea in patients with PH and a previous history of RFA for AF management. Early recognition and treatment can prevent complete occlusion of the affected PV and lead to an improvement in the patient’s symptoms and quality of life.
Keywords: Atrial Fibrillation, Dyspnea, Pulmonary Veins, Stents