title: [Hemoptysis because of pulmonary vein stenosis and occlusion after pulmonary vein isolation for atrial fibrillation].
abstract: METHODS
  A 49-year-old woman was admitted because of hemoptysis for four months. Several bronchoscopies and thoracic computed tomographies at other hospitals had not revealed the cause of the sustained hemoptysis. Eight months before admission she had undergone pulmonary vein ablation (PVA) for paroxysmal atrial fibrillation. After the PVA she had initially received oral anticoagulation, but this had been stopped because of the hemoptysis. Physical examination at admission to our hospital was unremarkable except for moderate obesity and arterial hypertension
  
  
  METHODS
  Ventilation/perfusion scintigraphy demonstrated combined ventilation and perfusion deficits in the left lower lobe. Transesophageal echocardiography strongly suggested stenoses of the left pulmonary veins. 3-D reconstruction of previously recorded computed tomographic images showed absence of the left inferior pulmonary vein (LIPV) and marked stenosis of the left superior pulmonary vein (LSPV).
  
  
  METHODS
  It was confirmed that the hemoptysis was caused by stenosis of the left pulmonary veins, resulting from the previous PVA.
  
  
  METHODS
  Percutaneous transseptal balloon dilatation of the upper and lower pulmonary veins was successfully performed. The patient was put on oral anticoagulation and discharged home free of symptoms.
  
  
  CONCLUSIONS
  Pulmonary vein stenosis must be considered as the most likely cause of hemoptysis and respiratory symptoms after pulmonary vein ablation for atrial fibrillation. Because of ever more frequent interventions to treat atrial fibrillation and other atrial arrhythmias, great clinical vigilance and an interdisciplinary approach is mandatory to assure optimal assessment of patients with acquired pulmonary vein stenosis.
authors: Medizinische Klinik I - Pneumologie, Universitätsklinikum Carl Gustav Carus Dresden. Silke.Braun@uniklinikum-dresden.de
authors: S
authors: S
authors: Braun
authors: M
authors: M
authors: Kolditz
authors: M
authors: M
authors: Halank
authors: M
authors: M
authors: Weise
authors: I
authors: I
authors: Platzek
authors: P
authors: P
authors: Sommer
authors: G
authors: G
authors: Höffken
mesh_terms: D000284:Administration, Oral; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000601:surgery*; D002404:Catheterization; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D055420:Perfusion Imaging; D011183:Postoperative Complications / Q000175:diagnosis*; D011667:Pulmonary Veins / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio
chemical_list: D000925:Anticoagulants