An unusual case of acute respiratory failure in a patient with pulmonary veins stenosis late after catheter ablation of atrial fibrillation: a case report and the review of the literature.
BACKGROUND
Atrial fibrillation (AF) can be treated with percutaneous catheter ablation procedures into the left atrium. Pulmonary veins stenosis (PV) stenosis is a severe complication of this procedure.


METHODS
we report a case of late hemoptysis secondary to severe PV stenosis in a man who underwent AF ablation 9 months before onset of symptoms. He presented four episodes of bleeding and developed an acute respiratory failure (ARF). Parameters of respiratory mechanics and medical investigation did not show any abnormalities. Only computed tomography (CT) angiography showed stenosis of 3 out of 4 native PVs. PV balloon dilatation in all affected PVs and a stent was implanted in 1 of the 3 PVs with full restoration of respiratory function during 1 year follow-up.


CONCLUSIONS
PV stenosis may be the underlying cause of recurrent haemoptysis after AF ablation in the presence of normal respiratory parameters. This diagnosis can be confirmed by means of CT angiography and magnetic resonance imaging can provide accurate localization of stenosis.
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy. savinospadaro@gmail.com.
Savino
S
Spadaro
Department of Morphology, Surgery and Experimental Medicine, Respiratory Medicine, S.Anna Hospital, Ferrara, Italy. strsra@unife.it.
Sara
S
Saturni
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy. delia_cd@libero.it.
Delia
D
Cadorin
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy. mv.colamussi@ospfe.it.
Maria V
MV
Colamussi
Department of Cardiology, S. Anna Hospital, University of Ferrara, Ferrara, Italy. doc.matber@gmail.com.
Matteo
M
Bertini
Department of Morphology, Surgery and Experimental Medicine, Vascular and interventional radiology Unit. S. Anna Hospital, Ferrara, Italy. roberto.galeotti@unife.it.
Roberto
R
Galeotti
Centro di Ricerca Aritmologia Clinica ed Elettrofisiologia, Milano, Rozzano, Italy. riccardo.cappato@humanitas.it.
Riccardo
R
Cappato
Department of Morphology, Surgery and Experimental Medicine, Respiratory Medicine, S.Anna Hospital, Ferrara, Italy. rvf@unife.it.
Franco
F
Ravenna
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy. vlc@unife.it.
Carlo A
CA
Volta
D000208:Acute Disease; D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed