Dynamical improvement after rescue balloon angioplasty for pulmonary vein occlusion complicated with radiofrequency catheter ablation.

Abstract

A 71-year-old man was referred to our hospital owing to hemoptysis. Pulmonary vein (PV) isolation by radiofrequency ablation with atrial fibrillation was performed twice 3 years prior. Bronchoscopy revealed a left bronchial hemorrhage (Figure A). Multidetector computed tomography (CT) revealed left superior and inferior PV (LIPV) occlusion (Figure B). There was reduced perfusion to the left upper and inferior lobes in Tc-99m macroaggregated albumin (MAA) (Figure D). First, the pulmonary artery pressure (PAP) was measured as 59/30 (42) mmHg, and PA angiography showed LIPV occlusion (Figure F, Supplementary data online, Movie S1). After a transseptal puncture, a 5 Fr multipurpose catheter was inserted through a deflectable sheath (Agilis, Abbott) near the LIPV occlusion site. A 0.035 in Radifocus guidewire and 5 Fr multipurpose catheter were successfully crossed into the LIPV occlusion, and then PV angiography showed LIPV occlusion (Figure G). A 0.014 in guidewire was exchanged with a microcatheter. Intravascular ultrasound (IVUS) showed a soft tissue-like hypoechoic lesion at the LIPV ostium (Figures 1 and 2, Supplementary data online, Movie S2). A successful balloon angioplasty was performed using two over-the-wire (OTW) balloons (4.0/40 mm and 6.0/20 mm) (Figure H); LIPV was fully dilated on PV angiography (Figure I) and IVUS (Figure 3, Supplementary data online, Movie S3).