INTRODUCTION

Pulmonary vein stenosis (PVS) is a rare complication of pulmonary vein isolation for the treatment of atrial

fibrillation. Endovascular treatment is an effective treatment, although there is little experience worldwide.

OBJECTIVE

The objective of the present study was to report early efficacy and safety of pulmonary vein angioplasty (PVA)

METHOS

Single center retrospective study at a general hospital. All adult patients undergoing PVA were included.

Baseline characteristics and technical aspects of PVA were recorded. Efficacy was defined as the ability to dilate

pulmonary veins and reduction in stenosis by angiography and transesophageal echocardiography (TEE).

RESULTS

From December 2022 to May 2023, 7 PVA were performed in 3 patients. Two of those patients had a history of

multiple pulmonary vein (PV) isolation due to recurrent atrial fibrillation. Time from last PV isolation to diagnosis

was approximately 6 months in all cases and very early (15 days) for the restenosis. All patients referred to a

delay in diagnosis. Hemoptysis was present in all cases. PVA was performed for native stenosis (n=5) and

restenosis (N=2) after stenting. The upper left pulmonary vein was affected more frequently (n=4), followed by

right upper PV (n=2) and left lower PV (n=1). Right lower PV was not affected in any case. One patient presented

with three PVS, which later presented with restenosis in two PV stents. The remaining two patients presented

with single PVS in the upper left PV. All patients had a diagnosis with contrast computed tomography showing

severe stenosis (n=5 PV) and occlusion (n=2 veins). Both occlusions were on the same patient and on the same

PV, both before and after stenting. All procedures were performed under general anesthesia with TEE guidance,

and through the right femoral vein. TEE confirmed PV occlusion in only one PV. After transseptal puncture, PVA

was performed with coronary equipment including a guiding catheter and a 0.014’’ guide wire. Only in the first

PVA, a simultaneous pulmonary artery injection was performed for visualizing the PV in a levophase. A dedicated

0.014’’ guidewire for chronic total occlusion was used in the case of PV occlusion. All native PVS were treated

with bare metal balloon expandable stents that were 6 mm (n=2), 7 mm (n=1) or 10 mm (n=2) in diameter. Stent

size was chosen based on computed tomography and angiography. Both stent restenosis occurred at PV treated

with a 6 mm stent, and were subsequently treated with a 7 mm drug coated balloon. All PVA showed satisfactory

results with reduction in TEE velocity (mean reduction was 33%). One patient experienced cardiac tamponade

after stenting of a lower left PV with a 10 mm stent. All patients experienced improvement in symptoms without

any mortality. One patient experienced pericarditis with mild pericardial effusion

CONCLUSION

In this early experience of patients with PVS, PVA is effective and safe. Larger registries are needed to confirm

early experience. Restenosis was associated with small stents.