Transesophageal echocardiography in comparison with magnetic resonance imaging in the diagnosis of pulmonary vein stenosis after radiofrequency ablation therapy.
OBJECTIVE
Doppler-derived flow velocity measured by transesophageal echocardiography (TEE) may overestimate pulmonary vein stenosis. We hypothesized that combining peak velocity with a stenotic flow pattern improves diagnosis compared with magnetic resonance imaging (MRI).


METHODS
TEE and MRI were performed in 44 patients 19 +/- 11 months after radiofrequency catheter ablation. Pulmonary vein stenosis was defined by a peak velocity of 110 cm/s or more plus a stenotic flow pattern (turbulence and reduced flow variation) on TEE and a lumen reduction of more than 50% on MRI.


RESULTS
In all, 175 pulmonary veins were studied. MRI showed 7 cases of pulmonary vein stenosis that were correctly identified by TEE. In addition, TEE criteria for pulmonary vein stenosis were met in 4 pulmonary veins that did not show obstruction on MRI. In all, 5 pulmonary veins with normal appearance on MRI had peak velocity of 110 cm/s or more with normal flow pattern.


CONCLUSIONS
TEE Doppler measurements can be reliably used to detect or exclude significant pulmonary vein stenosis if the diagnosis is restricted to a combination of elevated peak velocity (> or = 110 cm/s) with turbulence and little flow variation.
Jander
Nikolaus
N
Herz-Zentrum, Bad Krozingen, Germany. nikolaus.jander@herzzentrum.de
Minners
Jan
J
Arentz
Thomas
T
Görnandt
Lothar
L
Fürmaier
Rudolf
R
Kalusche
Dietrich
D
Neumann
Franz Josef
FJ
D017115:Catheter Ablation / Q000706:statistics & numerical data*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome