支架植入术治疗房颤射频消融术后严重肺静脉狭窄的疗效观察

Clinical observation of stent implantation for severe pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation

目的探讨支架植入术治疗房颤射频消融术(RFA)后严重肺静脉狭窄的临床疗效及安全性。方法选择接受房颤RFA治疗的231例患者进行回顾分析,其中8例患者经CT血管成像(CTA)证实术后出现严重肺静脉狭窄。在行血管造影确定病变血管数量、部位及狭窄程度后,在病变部位置入支架,随访观察临床疗效。结果 8例患者均顺利完成介入手术治疗,共发现病变血管19支,均植入支架。支架植入术后患者血管狭窄程度、跨狭窄压力阶差、平均肺动脉压及血浆钠尿肽(BNP)水平与支架植入术前相比均显著降低(P<0.01)。最窄处肺静脉内径与支架植入术前相比明显增宽(P<0.01)。术后半年复查CTA,2例患者共4支血管出现轻-中度再狭窄,给予高压球囊扩张后狭窄消失。扩张术后3个月CTA复查,所有患者均未见明显狭窄出现。结论支架植入术治疗房颤射频消融术后严重肺静脉狭窄近期疗效满意,安全可行。

Objective To investigate the efficiency and safety of stent implantation for severe pulmonary veto stenosls atter radiofrequency ablation （RFA） of atrial fibrillation. Methods The clinical date of 231 cases with atrial fibrillation received RFA treatment were analyzed retrospectively. Eight cases were confirmed with severe pulmonary vein stenosis after RFA by CTA. The stents were implanted after angiography. Results All the 19 serious pulmonary vein stenosis from the 8 patients were treated stent implantation. The degree of pulmonary vein stenosis, trans-stenotic gradient, mean pulmonary pressure and the level of BNP were significantly decreased after treatment （P〈0.01）. The minimal diameter of the stenosis was significantly increased compared with preoperative （P〈0.01）. Six months after stenting,2 patients in 4 pulmonary veins were stenosis. The stenosis was successfully di- lated by repeated interventions with balloon dilation. There was no stenosis appeared in the patients after the repeated interventions with balloon dilation for 3 months. Conclusion Stenting implantation was a feasible and safety method for severe pulmonary vein stenosis after RFA.