Pulmonary Vein Stenting With Hemodynamics and Intravascular Ultrasound Guidance

Area of Science:

• Cardiology
• Interventional Cardiology
• Pulmonary Hypertension

Background:

• Pulmonary venous stenosis (PVS) is a rare complication following atrial fibrillation pulmonary vein isolation.
• Vague symptoms often lead to delayed diagnosis of PVS.
• Stenting is a potential therapeutic option for select PVS cases.

Observation:

• A 49-year-old woman presented with dyspnea and hemoptysis a year after atrial fibrillation ablation.
• She was diagnosed with left inferior pulmonary vein (LIPV) stenosis and left superior pulmonary vein occlusion.
• Hemodynamics revealed severe segmental pulmonary hypertension with elevated pulmonary capillary wedge pressure (PCWP).

Findings:

• The patient underwent successful LIPV stenting using intravascular ultrasound (IVUS) guidance and a drug-eluting stent.
• Post-stenting, the LIPV gradient resolved, and left PCWP decreased significantly.
• Hemoptysis symptoms completely resolved after the intervention.

Implications:

• This case demonstrates that PVS can cause significant segmental pulmonary hypertension and elevated PCWP.
• Intravascular ultrasound-guided stenting is an effective treatment for PVS, improving hemodynamics and resolving symptoms.
• Early diagnosis and intervention are crucial for managing this complication.