Percutaneous recanalization of totally occluded pulmonary veins after pulmonary vein isolation—intermediate‐term follow‐up. Issue 4 (27th March 2013)

• Record Type: Journal Article
• Authors: Hill, James; Qureshi, Athar M.; Worley, Sarah; Prieto, Lourdes R.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 82:Issue 4(2013:Oct. 01)
• Page Start: 585
• Page End: 591
• Publication Date: 2013-03-27
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24886
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24886-sec-0001" sec-type="section"> <title>Objectives</title> <p>Review mid‐term follow‐up of percutaneous intervention for post ablation total pulmonary vein occlusion (PVO).</p> </sec> <sec id="ccd24886-sec-0002" sec-type="section"> <title>Background</title> <p>Feasibility of percutaneous intervention for PVO has been described, but information remains limited.</p> </sec> <sec id="ccd24886-sec-0003" sec-type="section"> <title>Methods</title> <p>Patients with total PVO were retrospectively identified from our catheterization database. Medical records, catheterization reports, and outpatient follow‐up were reviewed.</p> </sec> <sec id="ccd24886-sec-0004" sec-type="section"> <title>Results</title> <p>Between April 2005 and February 2012, 16 patients were identified with a total of 18 PVOs. Symptoms included hemoptysis in 6/16 (46%), cough in 8/16 (50%), chest pain in 8/16 (50%), dyspnea in 13/16 (81%) with mean NYHA Class of 2.6 ± 0.6. Recanalization was accomplished in 14/18 (78%) veins: 11 treated with balloon dilation and 3 with stents. Median follow‐up for 13/14 veins was 13 (0–39) months (one patient with one PVO is awaiting follow‐up). Reocclusion occurred in 7/13 (54%) at mean follow‐up of 3.6 ± 1.6 months (6/10 post‐balloon dilation and 1/3 post‐stenting). Despite reocclusion, the reference vessel diameter increased from 4.8 ± 2.4 to 8.5 ± 4.2 mm (<italic>P</italic> < 0.001) between the first and second catheterization. Re‐recanalization and stent placement was accomplished in 5/6 (83%), with one reocclusion not attempted. At latest follow‐up 9/13 (69%) recanalized vessels remained patent and percent flow to affected lung quadrant increased from 7.4 ± 3.4% pre‐intervention to 14.3 ± 4.2% (<italic>P</italic> = 0.004). Mean NYHA Class improved to 1.4 ± 0.4 (<italic>P</italic> < 0.001).</p> </sec> <sec id="ccd24886-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Recanalization of total PVO can be accomplished with reasonable mid‐term patency, improved symptoms, and lung perfusion. Reocclusion is common, but vessel growth is often observed allowing placement of a reasonably sized stent at a second intervention. Staged intervention is often necessary to maintain patency. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>