© 2013, Wiley Periodicals, Inc. DOI: 10.1111/echo.12413
Echocardiography
Pulmonary Vein Stenosis Assessed by ThreeDimensional Transesophageal Echocardiography Diana Anjo, M.D., Jose Alberto de Agustın, Ph.D., Jose Luis Rodrigo, Ph.D., Carlos Macaya, Ph.D., and Leopoldo Perez de Isla, Ph.D. Cardiovascular Institute, San Carlos University Hospital, Profesor Martin Lagos s/n, Madrid, Spain
(Echocardiography 2014;31:E68–E69) Key words: three-dimensional transesophageal echocardiography, pulmonary vein stenosis, atrial fibrillation, catheter ablation A 43-year-old-man underwent radiofrequency ablation for symptomatic, drug resistant, paroxysmal atrial fibrillation. Two months later, he was
admitted due to progressive exertional dyspnea and hemoptysis. Physical examination and electrocardiogram were unremarkable. A newly mild
Figure 1. A. Color Doppler showing a turbulent blood flow in the LUPV. B. Increased peak velocity documented with continuous-wave Doppler. C. Three-dimensional transesophageal echocardiogram showing the LUPV stenosis (arrow) by direct en face visualization from the left atrium. D. Planimetry at the level of the LUPV stenosis by multiplanar review (MPR) mode. LA = left atrium; LAA = left atrial appendage; LUPV = left upper pulmonary vein. Address for correspondence and reprint requests: Diana Oliveira Lopes Anjo, M.D., Rua Calouste Gulbenkian, no. 231, 5ºHab3, 4050-145 Porto, Portugal. Fax: +34913303290; E-mail: [email protected]
E68
Pulmonary Vein Stenosis Assessed by 3D TEE
pulmonary hypertension stood out in the transthoracic echocardiogram (preprocedure systolic pulmonary artery pressure 26 mmHg; postprocedure 37 mmHg). On suspicion of a complication of the intervention a transesophageal echocardiogram (TEE) was performed. The color Doppler revealed a turbulent blood flow in the left upper pulmonary vein (LUPV) (Fig. 1A) and an increased peak velocity was documented with continuous-wave Doppler echocardiography (Fig. 1B). Live three-dimensional (3D) TEE using a fully sampler 3D transducer (Philips iE33, Andover, MA, USA) was performed, improving the morphological characterization of the LUPV, including direct en face visualization from the left atrium (Fig. 1C, arrow; movie clip 1). Multiplanar review mode was used to perform the planimetry at the level of LUPV stenosis, resulting 0.2 cm2, indicative of severe obstruction (Fig. 1D). The
patient underwent balloon dilation and stenting without any complications. Pulmonary vein stenosis is a rare but serious complication of catheter ablation of atrial fibrillation. The high quality morphological evaluation by 3DTEE associated with the functional data provided by two-dimensional TEE makes this exam a unique tool in the assessment of this complication. Supporting Information Additional Supporting Information may be found in the online version of this article: Movie clip 1. Live three-dimensional (3D) transesophageal echocardiogram using a fully sampler 3D transducer, improving the morphological characterization of the left upper pulmonary vein stenosis; described in Figure 1C.
E69
Echocardiography
Pulmonary Vein Stenosis Assessed by ThreeDimensional Transesophageal Echocardiography Diana Anjo, M.D., Jose Alberto de Agustın, Ph.D., Jose Luis Rodrigo, Ph.D., Carlos Macaya, Ph.D., and Leopoldo Perez de Isla, Ph.D. Cardiovascular Institute, San Carlos University Hospital, Profesor Martin Lagos s/n, Madrid, Spain
(Echocardiography 2014;31:E68–E69) Key words: three-dimensional transesophageal echocardiography, pulmonary vein stenosis, atrial fibrillation, catheter ablation A 43-year-old-man underwent radiofrequency ablation for symptomatic, drug resistant, paroxysmal atrial fibrillation. Two months later, he was
admitted due to progressive exertional dyspnea and hemoptysis. Physical examination and electrocardiogram were unremarkable. A newly mild
Figure 1. A. Color Doppler showing a turbulent blood flow in the LUPV. B. Increased peak velocity documented with continuous-wave Doppler. C. Three-dimensional transesophageal echocardiogram showing the LUPV stenosis (arrow) by direct en face visualization from the left atrium. D. Planimetry at the level of the LUPV stenosis by multiplanar review (MPR) mode. LA = left atrium; LAA = left atrial appendage; LUPV = left upper pulmonary vein. Address for correspondence and reprint requests: Diana Oliveira Lopes Anjo, M.D., Rua Calouste Gulbenkian, no. 231, 5ºHab3, 4050-145 Porto, Portugal. Fax: +34913303290; E-mail: [email protected]
E68
Pulmonary Vein Stenosis Assessed by 3D TEE
pulmonary hypertension stood out in the transthoracic echocardiogram (preprocedure systolic pulmonary artery pressure 26 mmHg; postprocedure 37 mmHg). On suspicion of a complication of the intervention a transesophageal echocardiogram (TEE) was performed. The color Doppler revealed a turbulent blood flow in the left upper pulmonary vein (LUPV) (Fig. 1A) and an increased peak velocity was documented with continuous-wave Doppler echocardiography (Fig. 1B). Live three-dimensional (3D) TEE using a fully sampler 3D transducer (Philips iE33, Andover, MA, USA) was performed, improving the morphological characterization of the LUPV, including direct en face visualization from the left atrium (Fig. 1C, arrow; movie clip 1). Multiplanar review mode was used to perform the planimetry at the level of LUPV stenosis, resulting 0.2 cm2, indicative of severe obstruction (Fig. 1D). The
patient underwent balloon dilation and stenting without any complications. Pulmonary vein stenosis is a rare but serious complication of catheter ablation of atrial fibrillation. The high quality morphological evaluation by 3DTEE associated with the functional data provided by two-dimensional TEE makes this exam a unique tool in the assessment of this complication. Supporting Information Additional Supporting Information may be found in the online version of this article: Movie clip 1. Live three-dimensional (3D) transesophageal echocardiogram using a fully sampler 3D transducer, improving the morphological characterization of the left upper pulmonary vein stenosis; described in Figure 1C.
E69
