title: Aortic injury is common following pulmonary vein isolation.
abstract: BACKGROUND
  Esophageal injury has been documented following pulmonary vein isolation (PVI), but damage to other mediastinal structures such as the aorta is seldom reported. Hyperenhancement of the aorta is occasionally seen on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR LGE) in patients undergoing PVI.
  
  
  OBJECTIVE
  To determine the frequency of aortic wall LGE following PVI.
  
  
  METHODS
  Patients undergoing PVI with pre- and post-CMR LGE at our institution between January 2009 and September 2011 were retrospectively identified. Patients undergoing MiniMaze at our institution between March 2006 and September 2010 with pre- and post-CMR LGE were retrospectively identified and used as a control group. Studies were assessed for hyperenhancement, which is defined as LGE of the aorta or left atrium (LA) at 10 SD above the mean signal intensity of the aortic blood pool.
  
  
  RESULTS
  Forty-seven patients undergoing PVI and 14 patients undergoing MiniMaze were included in this analysis. A significant increase in the number of patients with aortic wall LGE was found post-PVI compared with pre-PVI (28 of 47 vs 14 of 47; P = .018). Ninety-six percent (26 of 27) of those with aortic wall enhancement post-PVI also had post-PVI LA enhancement. Eighty-six percent (24 of 28) of patients with aortic wall LGE post-PVI had direct contact of the LA and aorta on the pre-PVI CMR. Patients undergoing MiniMaze did not exhibit a significant increase in LA or aortic enhancement following surgery.
  
  
  CONCLUSIONS
  Rates of aortic wall LGE were increased among patients undergoing PVI but not MiniMaze, despite a trend toward larger LA in the latter group. The clinical implications of aortic LGE remain undefined. However, these data suggest that hyperenhancement of the aorta following PVI is common.
authors: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. ptung@bidmc.harvard.edu
authors: Patricia
authors: P
authors: Tung
authors: Susie N
authors: SN
authors: Hong
authors: Raymond H
authors: RH
authors: Chan
authors: Dana C
authors: DC
authors: Peters
authors: Thomas H
authors: TH
authors: Hauser
authors: Warren J
authors: WJ
authors: Manning
authors: Mark E
authors: ME
authors: Josephson
mesh_terms: D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000293:injuries*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005682:Gadolinium; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011667:Pulmonary Veins / Q000601:surgery*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery
chemical_list: D005682:Gadolinium