Abstract 17260: Percutaneous Recanalization of Totally Occluded Pulmonary Veins After Pulmonary Vein Isolation

Abstract

Background: Pulmonary vein total occlusion (PVO) is an uncommon complication of pulmonary vein isolation (PVI). We have previously published our early experience with diagnosis and treatment of PVO, and now describe mid-term follow-up of attempted recanalization. Methods: Patients with angiographic PVO were identified from our catheterization database. Medical records and catheterization reports were reviewed for: symptoms, flow to affected lung quadrant, time from PVI to diagnosis of PVO, anatomic characteristics of occluded veins, and procedural details. Patients with severely hypoplastic veins had staged intervention with initial balloon angioplasty followed by stenting 2-4 months later to allow for vessel growth. Symptoms, quadrant flow, and status of the vein at last follow-up were ascertained. Results: Between 6/2005 and 6/2011, 14 patients with PVO underwent attempted recanalization. Median age was 56.9 (0.2-67.3) years, weight 88 (5.0-111.4) kg. Symptoms included dyspnea in 11, cough in 4, hemoptysis in 5 with a mean NYHA class of 2.1 ± 0.8. Flow to affected lung quadrant was severely diminished at 5.9 ± 3.7%. Median time from PVI to recanalization attempt was 16.5 (2.0-62.7) months. Reference vessel diameter was 5.3 ± 2.0 mm and length of occluded segment 8.3 ± 6.0 mm. Recanalization results are summarized in Table 1. At median follow-up of 13.3 (0-41.3) months, 10 veins remain patent with minimal diameter of 6.1 ± 2.7 mm, reference diameter of 7.8 ± 3.1 mm, and flow to affected lung quadrant 12.3 ± 7.2%, all significantly greater than pre-intervention (p<0.03). Of 10 patients completing staged intervention, 5 have no symptoms and mean NYHA class decreased to 1.5 ± 0.7. Conclusions: PVO recanalization can be accomplished with reasonable acute and mid-term vessel patency and significant improvement in symptoms and flow to affected lung quadrant. However, recurrent stenosis is common and repeated interventions are often necessary to maintain vessel patency.