Pulmonary Vein Stenting With Hemodynamics and Intravascular Ultrasound Guidance

Pulmonary venous stenosis (PVS) is a rare but serious complication of atrial fibrillation pulmonary vein isolation, often diagnosed late because of vague symptoms. Stenting is a potential treatment in select cases.

A 49-year-old woman with atrial fibrillation underwent pulmonary vein isolation a year ago and presented multiple times with dyspnea and hemoptysis. She was eventually diagnosed with PVS of the left inferior pulmonary vein (LIPV) and occlusion of the left superior pulmonary vein. Invasive hemodynamics showed segmental pulmonary hypertension, with an elevated pulmonary capillary wedge pressure (PCWP) of 53 mm Hg in the affected lung vs 22 mm Hg in the unaffected side. She underwent LIPV stenting using intravascular ultrasound guidance and a drug-eluting stent. After stenting, no gradient remained across the LIPV, and the left PCWP dropped to 26 mm Hg. Hemoptysis resolved.

This case highlights segmental worse pulmonary hypertension and PCWP due to PVS, effectively treated with intravascular ultrasound-guided stenting.