Estenosis de venas pulmonares post ablación por radiofrecuencia / Pulmonary vein stenosis after radio frequency ablation

Es importante estar atento ante la aparición de síntomas respiratorios luego de la realización de un procedimiento de ablación por radiofrecuencia en el tratamiento de la fibrilación auricular, pues la estenosis de venas pulmonares (EVP) tiene una incidencia de entre 1 y 3% y puede aparecer hasta en los dos años posteriores al procedimiento1. Presentamos el caso de un paciente de 41 años de sexo masculino, que ingresó por un cuadro de hemoptisis y toracodinia de tres semanas de evolución, con antecedente de ablación por radiofrecuencia 6 meses antes de la admisión. La angiotomografía no evidenció tromboembolismo pulmonar (TEP) y la angiorresonancia detectó hipoperfusión deI lóbulo superior del pulmón izquierdo (LSI). Debido a los antecedentes de ablación se solicitó angiotomografía de venas pulmonares, que evidenció estenosis de la vena del LSI. Se realizó estudio hemodinámico con dilatación y colocación de stent.

Physicians should be alert to the occurrence of respiratory symptoms after radio frequency ablation for the treatment of atrial fibrillation. Pulmonary veins stenosis could appear with an incidence of between 1and 3% during the two years following the procedure. We present the case of a 41year-old-male patient admitted with a three weeks old hemoptysis and thoracodinia and a prior history of a radiofrecuency ablation procedure performed six months earlier. The angiotomography was not compatible with the diagnosis of pulmonary embolism and the angio-MRI detected hypoperfusion of the left upper pulmonary lobe. Consequently pulmonary veins angiotomography was requested, showing upper pulmonary lobe vein stenosis. An hemodynamic study with vein expansion and stent placement was successfully performed.

Tratamento cirúrgico da estenose do túnel das veias pulmonares após Senning modificado / Surgical treatment of pulmonary venous baffle obstruction after modified Senning procedure

Paciente de 13 anos de idade, sexo masculino, submetido à correção de estenose de túnel das veias pulmonares (ETVP) após cirurgia de Senning modificada realizada aos 5 meses. O quadro clínico era de congestão pulmonar e broncopneumonias de repetição e o ecocardiograma confirmou ETVP. Uma angioplastia com balão foi realizada previamente à correção cirúrgica com circulação extracorpórea. A placa de pericárdio bovino empregada para ampliação do átrio direito retraiu-se e calcificou, levando a ETVP. A placa foi removida e o átrio direito foi ampliado com um retalho de politetrafluoretileno. O ecocardiograma transesofágico intraoperatório demonstrou redução significativa da estenose.

A 13-year-old male was admitted to undergoing correction of a pulmonary venous baffle stenosis (PVBS) after a modified Senning procedure was performed by the age of five months. Recurrent Pulmonary congestion and pneumonia episodes were followed by echocardiography and cardiac catheterization that confirmed PVBS. Previous catheter balloon angioplasty was attempted, and a surgical revision was done under cardiopulmonary bypass. The bovine pericardial patch used for augmentation of the right atrium, retracted and calcified producing PVBS. Stenotic area was excised and enlargement was done with polytetrafluoroethylene membrane. Intraoperative transesophageal echocardiogram showed relief of stenosis.

Tratamento de estenose de veia pulmonar após ablação percutânea de fibrilação atrial / Treatment of pulmonary vein stenosis after percutaneous ablation of atrial fibrillation / Tratamiento de estenosis de vena pulmonar tras ablación percutánea de fibrilación atrial

Neste relato de caso, descrevemos um paciente portador de fibrilação atrial (FA) persistente, submetido à ablação percutânea da FA pela técnica de isolamento extraostial das veias pulmonares, que desenvolveu uma estenose acentuada do óstio da veia pulmonar superior esquerda (VPSE), sem manifestar sintomas, diagnosticada pela angiotomografia de controle das veias pulmonares. O paciente foi submetido à angioplastia com implante de stent na VPSE com sucesso, resultando na normalização da perfusão pulmonar, verificado pela cintilografia pulmonar realizada 3 meses após a angioplastia.

This case report describes a patient with persistent atrial fibrillation (AF) submitted to radiofrequency catheter ablation of AF through the pulmonary vein antrum isolation technique, who developed a severe stenosis of the left superior pulmonary vein (LSPV), without presenting any symptoms. The diagnosis of the PV stenosis was made by a routine postprocedure computed tomography scan of the left atrium, and the patient was subsequently submitted to angioplasty with stenting of the LSPV, resulting in the normalization of pulmonary perfusion, as seen by ventilation/perfusion scan made three months after the LSPV angioplasty.

En este caso clínico, describimos a un paciente portador de fibrilación atrial (FA) persistente, sometido a ablación percutánea de la FA por la técnica de aislamiento extraostial de las venas pulmonares, que desarrolló una estenosis acentuada del ostio de la vena pulmonar superior izquierda (VPSI), sin manifestar síntomas, diagnosticada por la angiotomografía de control de las venas pulmonares. El paciente se sometió a angioplastia con implante de stent en la VPSI con éxito, resultando en la normalización de la perfusión pulmonar, verificado por el centellograma pulmonar realizada 3 meses tras la angioplastia.