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