Sténose des veines pulmonaires après radiofréquence pour fibrillation atriale

Abstract

Pulmonary vein stenosis is a rare condition with a high mortality. With the advent of radiofrequency ablation for atrial fibrillation a new cause of pulmonary vein stenosis has emerged. We report two cases of severe pulmonary vein stenosis. In the first case the diagnosis was obtained rapidly and balloon angioplasty with stent implantation was performed in the two left pulmonary veins. Recurrent occlusion occurred within the stents, extensive pulmonary infiltrates resembling pulmonary venous infarction developed and the patient died. In the second case the diagnosis was missed initially because the clinical picture suggested thrombo-embolic disease or infection. Balloon angioplasty with stent implantation was performed later. Restenosis occurred after 18 months. These two cases illustrate the frequency with which percutaneously inserted venous prostheses thombose. Clinicians should be familiar with the possibility of the development of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. Pulmonary vein stenosis remains a difficult condition to manage. The pulmonary infarction should probably be considered as an urgent indication for surgical resection or even transplantation.