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Ann Thorac Surg 2010;89:340. doi:10.1016/j.athoracsur.2009.06.056
© 2010 The Society of Thoracic Surgeons
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Correspondence

Complete Pulmonary Venous Occlusion After Radiofrequency Ablation

Chung-Dann Kan, MD, Yu-Jen Yang, MD, PhD

Department of Surgery, Institute of Clinical Medicine and Cardiovascular Research Center, National Cheng Kung University Hospital, 138 Sheng-Li Rd, Tainan, 704, Taiwan, Republic of China

(Email: kcd56{at}mail.ncku.edu.tw).

To the Editor:

We read with great interest the article by Nehra and colleagues [1] who report their strategy for treating pulmonary vein occlusion caused by radiofrequency ablation by pneumonectomy. Radiofrequency catheter ablation has evolved in the last decade as an exciting and curative modality for the treatment of medically refractory atrial fibrillation [2]. Pulmonary vein obstruction, however, is its new, major and potentially life-threatening complication. The pathophysiology arises from heat-induced fibrosis and contraction of the scar within or at the orifice of the pulmonary veins. How to save these patients from critical illness conditions is a major issue. Traditional pulmonary vein repair or stenting was associated with a high rate of re-stenosis and elevated mortality. Total pneumonectomy is a good alternative modality; however, it also seems to be too harmful for the patient. Because the obstruction might be anatomically limited between the left atrium and the pulmonary vein orifices [3], would the authors try to perform the sutureless pericardial marsupialization technique that was used for stenosis after repair of total anomalous pulmonary venous return [4]? Recently, a 5-month-old baby, diagnosed with right atrial isomerism, transposition of the great artery, complete endocardial cushing defect, and total anomalous pulmonary venous return (supracardiac) by echocardiography, underwent the pulmonary venous rerouting procedure smoothly. Unfortunately, severe left-sided pulmonary vein stenosis was noted 4 months later. The patient was successfully managed by a pericardial marsupialization technique (Fig 1).


Figure 1
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  		Fig 1. Left inferior pulmonary vein orifice stenosis was resected (indicated by black arrow) seen from the atrial side. The intact pericardium (indicated by white arrow) left outside. Using the pericardial flap (black dotted line indicated the sewn line) to avoid direct suturing to the vein to complete the marsupialization.

 


   References
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 References
 

  1. Nehra D, Liberman M, Vagefi PA, et al. Complete pulmonary venous occlusion after radiofrequency ablation for atrial fibrillation Ann Thorac Surg 2009;87:292-295.[Abstract/Free Full Text]
  2. Purerfellner H, Martinek M. Pulmonary vein stenosis following catheter ablation of atrial fibrillation Curr Opin Cardiol 2005;20:484-490.[Medline]
  3. Combes N, Boveda S, Lapeyre M, Marijon E. Acute pulmonary vein stenosis after radiofrequency catheter ablation J Cardiovasc Electrophysiol 2009;20:569-570.[Medline]
  4. Devaney EJ, Ohye RG, Bove EL. Pulmonary vein stenosis following repair of total anomalous pulmonary venous connection Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:51-55.

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Deepika Nehra, Ignacio Inglessis, and Henning A. Gaissert
Ann. Thorac. Surg. 2010 89: 340. [Extract] [Full Text] [PDF]



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D. Nehra, I. Inglessis, and H. A. Gaissert
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Ann. Thorac. Surg., January 1, 2010; 89(1): 340 - 340.
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