Minor pulmonary vein stenosis post RFCA

History
Six weeks after circumferential ablation of all PVs a 48-year old male is referred to CT for follow-up. On CT examination, the patient was not in AF and heart rate was 68 bpm.

Question
Presence of post-interventional pulmonary vein stenosis. Exclusion of rare complications such as atrial thrombi or pulmonary vein dissection.

Diagnosis/Differential diagnosis

• Common pulmonary venous drainage pattern with exclusion of variant veins
• Post-interventional non-significant stenosis of the upper right pulmonary vein
• Normal presentation of all other ostia and exclusion of atrial thrombi

Findings
The epicardial volume rendering shows a normal pulmonary venous drainage pattern without variant ostia. Thin MIPs which are focused on the long axes of pulmonary veins reveal a non-significant post-interventional stenosis of the upper right pulmonary vein (arrow). Normal venous ostia are shown for the lower right and the upper left pulmonary vein.

Comments
Even in a non-gated single source mode, Dual Source CT provides excellent image quality, and, thereby allows for accurate depiction of left atrial anatomy or proximal pulmonary veins.

[1] Epicardial VR of the left atrium	[2] Coronal MIP is showing a mild, non-relevant, post-interventioanl lumen narrowing of the right upper pulmonary vein (arrow). The lower left pulmonary vein is visualized without pathology.
[3] Angulated MIP displaying the lower right pulmonary vein.	[4] Angulated MIP showing the normal upper left vein.

Authors: Brodoefel H, Heuschmid M, Kopp AF
See corresponding news: Using DSCT for Visualizing Pulmonary Veins
See corresponding case: Significant pulmonary vein stenosis
See corresponding protocol: Pulmonary veins