Co-Author(s):
Christopher Barrett, MD - University of Colorado Anschutz Medical Campus
Amneet Sandhu, MD - Veterans Administration Eastern Colorado Health Care
System
Alexis Tumolo, MD - University of Colorado Anschutz Medical Campus
Johannes Von Alvensleben, MD - Children’s Hospital Colorado
Matthew Zipse, MD - University of Colorado Anschutz Medical Campus
University of Colorado Anschutz Medical Campus
12631 East 17th Avenue, B130 Aurora, CO 80045
Introduction | Objectives: Pulmonary vein stenosis (PVS) is a known complication associated with
radiofrequency ablation (RFA) of the pulmonary veins. We present a
patient with surgically corrected total anomalous pulmonary venous
return (TAPVR) who developed PVS following RFA within an unroofed
coronary sinus (CS) for atypical atrial flutter.
Methods: NA
Results: A 39 year old man with cardiac-type TAPVR, with the confluence of
pulmonary veins draining into the CS surgically unroofed into the left
atrium in infancy, was referred to our institution for complications
related to RFA. He had previously undergone ablation of symptomatic
atypical flutter with RFA of the superior left atrium extending into the
unroofed CS ostium, to the pulmonary vein confluence. Despite acute
success, atrial flutter recurred weeks later prompting initiation of
propafenone. In the following months, he noted recurrent respiratory
tract infections, dry cough and palpitations resulting in referral for
repeat RFA. Pre-procedural CTA demonstrated marked dilation of the left
superior and inferior pulmonary veins (LSPV/LIPV) and moderate dilation
of the right superior and inferior pulmonary veins (RSPV/RIPV), but
no definite PVS. He underwent RFA from the roof of the left atrium into
the antrum of the LIPV within the unroofed CS, during which he acutely
developed hemoptysis and hypoxemia leading to transfer to our center.
CTA demonstrated occlusion of the LIPV, severe stenosis of the LSPV, and
moderate stenosis of the right sided pulmonary veins. The patient
underwent stenting of the LSPV with staged stenting of right sided veins
months later without recurrence of symptoms.
Conclusions: This patient with TAPVR developed severe PVS following RFA within an
unroofed CS. Due to the unique anatomy and potential risk for PVS,
congenital heart disease patients with a common pulmonary vein
confluence may benefit from pulmonary vein isolation via circumferential
ablation around the entire confluence rather than RFA near PVs within
the unroofed CS, as was done in this case3.
Multi-planar imaging is critical in preprocedural planning of RFA in
this patient population and diagnosing PVS. Pulmonary vein stenting is
the definitive treatment.
AFS 2021-45