心房颤动射频消融致肺静脉狭窄两例报告并文献复习

Pulmonary Vein Stenosis after Radiofrequency Ablation for Atrial Fibrillation: Two Cases Report and Literature Review

目的探讨心房颤动(简称房颤)射频消融致肺静脉狭窄患者的临床、影像学特点,提高对射频消融致肺静脉狭窄的认识。方法回顾性分析南京大学医学院附属鼓楼医院诊治的2例射频消融致肺静脉狭窄患者的临床及影像学资料,并复习相关文献。结果 2例患者均因房颤行环肺静脉电隔离术,均于术后2个月左右出现症状;临床主要表现为咳嗽、咯血、进行性呼吸困难及胸痛;患者均曾于外院误诊为肺炎等其他疾病,抗感染治疗无效;其胸部CT均可见局部的渗出性实变,伴不同程度的小叶间隔增厚及小结节影。患者最终均经CT肺静脉成像确诊为肺静脉狭窄。复习了21例房颤射频消融致肺静脉狭窄病例的临床资料,其临床症状以咯血、胸痛、劳力性呼吸困难及咳嗽最为常见,胸部影像学以实变影、磨玻璃影、胸腔积液及小叶间隔增厚最为常见。结论射频消融术后患者若出现咯血、呼吸困难、胸痛等临床表现,胸部影像学表现为局部的渗出性实变伴小叶间隔增厚及小结节影,应高度警惕肺静脉狭窄可能。应用CT肺静脉造影增强结合肺静脉三维成像技术,可以清楚显示各肺静脉的开口直径及其分支,是评价和诊断肺静脉狭窄及其严重程度的重要无创检查方法。

Objective To analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. Methods Clinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. Results Both patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough,hemoptysis,exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals,and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis,chest pain,shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation,groud-glass attenuation,pleural effusion and interstitial septal thickening. Conclusions If a patient presents with hemoptysis,dyspnea,chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules,the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches,so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.