PMC5420014_01
The 3-D images of the left atrium (posteroanterior and top view) constructed by multidetector computed tomography after the procedure demonstrated severe left superior pulmonary vein (LSPV) stenosis immediately posterior to the persistent left superior vena cava (PLSVC).
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In the left superior pulmonary vein (LSPV), the first freezing attempt was terminated at 45 seconds owing to an insufficient temperature drop, followed by successful additional attempts at freezing (180 and 120 seconds, minimum temperature of -48 C; fluoroscopic image in Supplemental Figure 1 and details of freezing in Supplemental Tables, available online). In the remaining 3 PVs, 2 sequential freezing attempts (180 and 120 seconds) were successfully performed. Although he had no AF recurrence thereafter, multidetector computed tomography at 3 months revealed significant LSPV stenosis ( 80% in LSPV, Figure 1).
Tc-99m macroaggregated albumin perfusion images are shown. There is reduced perfusion in the left upper lobe. ANT = anterior; LAO = left anterior oblique; LPO = left posterior oblique; POST = posterior; RAO = right anterior oblique; RPO = right posterior oblique.
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Although the patient remains free from any symptoms attributable to PV stenosis, there was reduction in perfusion to the left upper lobe (Figure 2).
A: Balloon dilation in the left superior pulmonary vein and B: angiography in the left superior pulmonary vein after venoplasty.
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A successful balloon angioplasty (Sterling, 8.0 x 20 mm, Boston Scientific, Marlborough, MA) was performed with use of the intravascular ultrasound (Figure 3).