心房颤动射频消融致肺静脉狭窄临床分析
|
摘要
目的:探讨心房颤动射频消融致肺静脉狭窄(PVS)患者的临床特点,旨在提高对该病的认识。方法:回顾性分析首都医科大学附属北京安贞医院诊治的3例射频消融致PVS患者的临床及影像学资料,并复习相关文献。结果:3例患者PVS均因心房颤动行射频消融术所致,临床表现为咳嗽、咳嗽、咯血、胸痛及劳力性呼吸困难,胸部影像表现为渗出实变影、胸腔积液,最终经肺血管MRA或CT肺血管造影确诊,1例接受了支架置入术,2例接受了药物保守治疗,随访4个月～9年,患者一般状况可,日常生活不受影响。复习了60例心房颤动射频消融致PVS病例的临床资料,男性50例,女性10例,年龄16～70岁。患者发病时距射频消融手术平均时间为5(2～7)个月,临床表现以劳力性呼吸困难、咯血、咳嗽、咳痰及胸痛最为常见,胸部影像以实变影、磨玻璃影、小叶间隔增厚及胸腔积液最为多见,治疗以介入治疗、肺叶切除及手术修复为主。结论:射频消融术后患者若出现咳嗽、咯血、胸痛及呼吸困难等临床表现,胸部影像表现为渗出实变影、磨玻璃影、胸腔积液及小叶间隔增厚,应警惕PVS可能,CT肺血管造影是评价和诊断PVS及其严重程度的重要无创检查方法。
Objective: To analyze the clinical features of pulmonary vein stenosis(PVS)after radiofrequency ablation and therefore to improve the understanding of this disease. Methods: The clinical features of 3 cases with PVS after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. Results: All patients had undergone radiofrequency ablation for atrial fibrillation. The major symptoms were cough, expectoration, hemoptysis, chest pain and exacerbation of dyspnea. Chest radiographic findings showed parenchymal exudative consolidation with pleural effusion. All patients were confirmed as PVS by MRA or CT angiography. One patient treated with stenting, and the others chose conservative approach with drugs. All patients were followed up via a telephone interview, and showed good functional capacity and quality of life. Literature review identified 60 cases of PVS after radiofrequency ablation for atrial fibrillation, including 50 males and 10 females(age from 16 to 70).The average duration between radiofrequency ablation to the onset of symptoms was 5(2-7) months. The main clinical features are exacerbation of dyspnea, hemoptysis, cough and chest pain. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, interstitial septal thickening and pleural effusion. The main therapeutic strategies were percutaneous intervention, pulmonary lobectomy and surgical repair. Conclusions: If a patient presents with cough, hemoptysis, chest pain, dyspnea or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation, groud-glass attenuation, pleural effusion with interstitial septal thickening, the possibility of PVS should be considered. CT angiography is an important non-invasive examination method for the evaluation and diagnosis of PVS.
Objective: To analyze the clinical features of pulmonary vein stenosis(PVS)after radiofrequency ablation and therefore to improve the understanding of this disease. Methods: The clinical features of 3 cases with PVS after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. Results: All patients had undergone radiofrequency ablation for atrial fibrillation. The major symptoms were cough, expectoration, hemoptysis, chest pain and exacerbation of dyspnea. Chest radiographic findings showed parenchymal exudative consolidation with pleural effusion. All patients were confirmed as PVS by MRA or CT angiography. One patient treated with stenting, and the others chose conservative approach with drugs. All patients were followed up via a telephone interview, and showed good functional capacity and quality of life. Literature review identified 60 cases of PVS after radiofrequency ablation for atrial fibrillation, including 50 males and 10 females(age from 16 to 70).The average duration between radiofrequency ablation to the onset of symptoms was 5(2-7) months. The main clinical features are exacerbation of dyspnea, hemoptysis, cough and chest pain. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, interstitial septal thickening and pleural effusion. The main therapeutic strategies were percutaneous intervention, pulmonary lobectomy and surgical repair. Conclusions: If a patient presents with cough, hemoptysis, chest pain, dyspnea or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation, groud-glass attenuation, pleural effusion with interstitial septal thickening, the possibility of PVS should be considered. CT angiography is an important non-invasive examination method for the evaluation and diagnosis of PVS.
引文
[1] 刘洁,庄少侠,陆国础,等.房颤导管消融致迟发性肺静脉狭窄一例.中华结核和呼吸杂志,2015,38:309-310.
[2] 孔令秋,唐红,冯沅,等.心房颤动射频消融术后肺静脉狭窄超声表现1例.中华超声影像学杂志,2014,23:661.
[3] 罗学胜,张红,刘建民,等.心房颤动患者射频消融术后肺静脉狭窄误诊分析.临床误诊误治,2012,25:62-64.
[4] Rostamian A,Narayan SM,Thomson L,et al. The incidence,diagnosis,and management of pulmonary vein stenosis as a complication of atrial fibrillation ablation.J Interv Card Electrophysiol,2014,40:63-74.
[5] Barrett CD,Di Biase L,Natale A.How to identify and treat patient with pulmonary vein stenosis post atrial fibrillation ablation.Curt Opin Cardiol,2009,24:42-49.
[6] Chen SA,Hsieh MH,Tai CT,et al.Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins:electrophysiological characteristics pharmacological responses,and effects of radiofrequency ablation.Circulation,1999,100:1879-1886.
[7] Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation.Circulation,2005,111:1100-1105.
[8] Packer DL,Keelan P,Munger TM,et al.Clinical presentation,investigation,and management of pulmonary vein stenosis complicating ablation for atrial fibrillation.Circulation,2005,111:546-554.
[9] Pürerfellner H,Aichinger J,Martinek M,et al.Incidence,management,and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation.Am J Cardiol,2004,93:1428-1431.
[10] 吴钢,黄从新,江洪.射频消融致肺静脉狭窄的病理特征.中华心血管病杂志, 2004,32:539-540.
[11] De Potter TJ,Schmidt B,Chun KR,et al.Drug-eluting stents for the treatment of pulmonary vein stenosis after atrial firillation ablation.Europace,2011,13:57-61.
[12] 杨延宗,王照谦,王鸣遒,等.多层螺旋cT在评价心房颤动导管射频消融电隔离术后肺静脉狭窄中的应用.中华心血管病杂志,2004,32:217-220.
[13] Hyde JA,Stumper O,Barth MJ,et al.Total anomalous pulmonary venous connection:outcome of surgical correction and management of recurrent venous obstruction.Eur J Cardiothorac Surg,1999,15:735-741.
[14] Michielon G,Di Donato RM,Pasquini L,et al.Total anomalous pulmonary venous connection:long-term appraisal with evolving technical solutions.Eur J Cardiothorac Surg,2002,22:184-191.
[15] Nanthakumar K,Mountz JM,Plumb VJ,et al.Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging.Chest,2004,126:645-651.
[16] Ravenel JG,McAdams HP.Pulmonary venous infarction after radiofrequency ablation for atrial fibrillation.Am J Roentgenol,2002,178:664-666.
[17] 王建德,李建蓉.肺静脉狭窄的诊治及进展.中华医学超声杂志(电子版),2010,7:1560-1565.
[2] 孔令秋,唐红,冯沅,等.心房颤动射频消融术后肺静脉狭窄超声表现1例.中华超声影像学杂志,2014,23:661.
[3] 罗学胜,张红,刘建民,等.心房颤动患者射频消融术后肺静脉狭窄误诊分析.临床误诊误治,2012,25:62-64.
[4] Rostamian A,Narayan SM,Thomson L,et al. The incidence,diagnosis,and management of pulmonary vein stenosis as a complication of atrial fibrillation ablation.J Interv Card Electrophysiol,2014,40:63-74.
[5] Barrett CD,Di Biase L,Natale A.How to identify and treat patient with pulmonary vein stenosis post atrial fibrillation ablation.Curt Opin Cardiol,2009,24:42-49.
[6] Chen SA,Hsieh MH,Tai CT,et al.Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins:electrophysiological characteristics pharmacological responses,and effects of radiofrequency ablation.Circulation,1999,100:1879-1886.
[7] Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation.Circulation,2005,111:1100-1105.
[8] Packer DL,Keelan P,Munger TM,et al.Clinical presentation,investigation,and management of pulmonary vein stenosis complicating ablation for atrial fibrillation.Circulation,2005,111:546-554.
[9] Pürerfellner H,Aichinger J,Martinek M,et al.Incidence,management,and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation.Am J Cardiol,2004,93:1428-1431.
[10] 吴钢,黄从新,江洪.射频消融致肺静脉狭窄的病理特征.中华心血管病杂志, 2004,32:539-540.
[11] De Potter TJ,Schmidt B,Chun KR,et al.Drug-eluting stents for the treatment of pulmonary vein stenosis after atrial firillation ablation.Europace,2011,13:57-61.
[12] 杨延宗,王照谦,王鸣遒,等.多层螺旋cT在评价心房颤动导管射频消融电隔离术后肺静脉狭窄中的应用.中华心血管病杂志,2004,32:217-220.
[13] Hyde JA,Stumper O,Barth MJ,et al.Total anomalous pulmonary venous connection:outcome of surgical correction and management of recurrent venous obstruction.Eur J Cardiothorac Surg,1999,15:735-741.
[14] Michielon G,Di Donato RM,Pasquini L,et al.Total anomalous pulmonary venous connection:long-term appraisal with evolving technical solutions.Eur J Cardiothorac Surg,2002,22:184-191.
[15] Nanthakumar K,Mountz JM,Plumb VJ,et al.Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging.Chest,2004,126:645-651.
[16] Ravenel JG,McAdams HP.Pulmonary venous infarction after radiofrequency ablation for atrial fibrillation.Am J Roentgenol,2002,178:664-666.
[17] 王建德,李建蓉.肺静脉狭窄的诊治及进展.中华医学超声杂志(电子版),2010,7:1560-1565.