Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the "right top pulmonary vein".
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.
Lickfett
Lars
L
Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-0409, USA.
Kato
Ritsushi
R
Tandri
Harikrishna
H
Jayam
Vinod
V
Vasamreddy
Chandrasekhar R
CR
Dickfeld
Timm
T
Lewalter
Thorsten
T
Luderitz
Berndt
B
Berger
Ronald
R
Halperin
Henry
H
Calkins
Hugh
H
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