Detection of pulmonary vein stenosis by transesophageal echocardiography: comparison with multidetector computed tomography.
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.
Sigurdsson
Gardar
G
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
Troughton
Richard W
RW
Xu
Xiao-Fang
XF
Salazar
Holger P
HP
Wazni
Oussama M
OM
Grimm
Richard A
RA
White
Richard D
RD
Natale
Andrea
A
Klein
Allan L
AL
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