title: Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the "right top pulmonary vein".
abstract: BACKGROUND
  Catheter ablation of the pulmonary veins (PVs) for prevention of recurrent atrial fibrillation requires precise anatomic information. We describe the characteristics of a new anatomic variant of PV anatomy using magnetic resonance angiography.
  
  
  RESULTS
  A 1.5-T magnetic resonance imaging system with a body coil or a torso phased-array coil was used before and after gadolinium injection. Magnetic resonance angiograms were acquired with a breath-hold three-dimensional fast spoiled gradient-echo imaging sequence in the coronal plane. Three-dimensional reconstruction with maximum intensity projections and multiplanar reformations was performed. A newly described variant PV ascending from the roof of the left atrium was found in 3 of 91 subjects. The mean ostial diameter of the roof PV was 7 +/- 2 mm, the mean distance from the ostium to the first branching point was 22 +/- 8.5 mm, and the mean distance to the right superior PV was 3.3 +/- 0.6 mm.
  
  
  CONCLUSIONS
  We refer to the newly described variant of PV anatomy as the "right top pulmonary vein." It is important to be aware of this anatomic pattern to avoid inadvertent catheter intubation, which can result in misleading mapping results and PV stenosis.
authors.affiliation: Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-0409, USA.
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Ritsushi
authors.initials: R
authors.lastname: Kato
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
authors.forename: Vinod
authors.initials: V
authors.lastname: Jayam
authors.forename: Chandrasekhar R
authors.initials: CR
authors.lastname: Vasamreddy
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Berndt
authors.initials: B
authors.lastname: Luderitz
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Henry
authors.initials: H
authors.lastname: Halperin
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000473:pathology* / Q000601:surgery; D014481:United States