title: Detection of pulmonary vein stenosis by transesophageal echocardiography: comparison with multidetector computed tomography.
abstract: OBJECTIVE
  The objective of this study is to compare the use of transesophageal echocardiography (TEE) vs multidetector computed tomography (MDCT) for detecting pulmonary vein stenosis.
  
  
  BACKGROUND
  Pulmonary vein isolation is increasingly used to treat atrial fibrillation. Pulmonary vein stenosis remains a potential complication of pulmonary vein isolation and ideal methods for detection of stenosis are still to be determined.
  
  
  METHODS
  Thirty-six subjects who underwent pulmonary vein isolation returned for follow-up MDCT and TEE. Percent diameter loss was reported for each pulmonary vein stenosis by MDCT. A 50% narrowing was considered as an indication of a stenosis. Pulsed-wave Doppler using TEE was used to measure peak velocities of all pulmonary veins.
  
  
  RESULTS
  Multidetector computed tomography and TEE were performed in all subjects (58 +/- 10 years) at 4 +/- 2 months after pulmonary vein isolation. Atrial fibrillation was present in 14% at time of follow-up. Multidetector computed tomography was able to evaluate all 4 (100%) pulmonary veins in 36 subjects, whereas full interrogation by TEE was possible in 138 (96%) of 144 veins. Pulmonary vein stenosis >50% by MDCT was present in 7 pulmonary veins. Analysis of the receiver operating curve for TEE showed that it had optimum detection of pulmonary vein stenosis at peak velocities approximately 100 cm/s with 86% sensitivity and 95% specificity. Area under the curve for TEE was 0.93. Clinically significant stenosis was observed in 2 subjects and was detected by both TEE and MDCT.
  
  
  CONCLUSIONS
  Transesophageal echocardiography was able to detect most pulmonary veins with good sensitivity and specificity in comparison to MDCT. Pulmonary veins may be visualized more frequently by MDCT; however, TEE provides additional data about the functional significance of a pulmonary vein stenosis.
authors: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Gardar
authors: G
authors: Sigurdsson
authors: Richard W
authors: RW
authors: Troughton
authors: Xiao-Fang
authors: XF
authors: Xu
authors: Holger P
authors: HP
authors: Salazar
authors: Oussama M
authors: OM
authors: Wazni
authors: Richard A
authors: RA
authors: Grimm
authors: Richard D
authors: RD
authors: White
authors: Andrea
authors: A
authors: Natale
authors: Allan L
authors: AL
authors: Klein
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods