Pulmonary vein obstruction after catheter ablation in a patient with partial anomalous pulmonary vein connection

A 75-year-old man with symptomatic atrial fibrillation was referred to our hospital for catheter ablation. Preprocedural echocardiogram showed mild-moderate degree mitral regurgitation (MR) and mild tricuspid regurgitation (TR) with transvalvular peak gradient (TVPG) of 27 mmHg. The complete isolation of the pulmonary veins was performed by radiofrequency ablation, and the patient was kept in sinus rhythm after the procedure. However, the exertional dyspnea had gradually developed one year after the procedure. Echocardiogram showed severe TR with TVPG 60 mmHg. MDCT showed partial anomalous pulmonary vein connection (PAPVC) of the left upper pulmonary vein and the occlusion of left lower pulmonary vein ostium: pulmonary venous flow of the left upper lung was drained into the brachiocephalic vein. The patient underwent surgical correction of PAPVC and annuloplasty of the mitral and tricuspid valve. Although it is unclear whether there is direct causal relationship between PAPVC and PV obstruction, anatomical evaluation of PVs is important in patients undergoing catheter ablation. <Learning objective: Partial anomalous pulmonary vein connection (PAPVC) is rare and often asymptomatic in adults. In the present case, pulmonary vein obstruction occurred after radiofrequency catheter ablation in a patient with PAPVC. Although pulmonary venous flow from only left upper lobe drained into the brachiocephalic vein before ablation, occlusion of the left lower pulmonary vein resulted in right heart failure one year after ablation.>.