Percutaneous recanalization of totally occluded pulmonary veins after pulmonary vein isolation-intermediate-term follow-up.

OBJECTIVES: Review mid-term follow-up of percutaneous intervention for post ablation total pulmonary vein occlusion (PVO).

BACKGROUND: Feasibility of percutaneous intervention for PVO has been described, but information remains limited.

METHODS: Patients with total PVO were retrospectively identified from our catheterization database. Medical records, catheterization reports, and outpatient follow-up were reviewed.

RESULTS: Between April 2005 and February 2012, 16 patients were identified with a total of 18 PVOs. Symptoms included hemoptysis in 6/16 (46%), cough in 8/16 (50%), chest pain in 8/16 (50%), dyspnea in 13/16 (81%) with mean NYHA Class of 2.6 ± 0.6. Recanalization was accomplished in 14/18 (78%) veins: 11 treated with balloon dilation and 3 with stents. Median follow-up for 13/14 veins was 13 (0-39) months (one patient with one PVO is awaiting follow-up). Reocclusion occurred in 7/13 (54%) at mean follow-up of 3.6 ± 1.6 months (6/10 post-balloon dilation and 1/3 post-stenting). Despite reocclusion, the reference vessel diameter increased from 4.8 ± 2.4 to 8.5 ± 4.2 mm (P < 0.001) between the first and second catheterization. Re-recanalization and stent placement was accomplished in 5/6 (83%), with one reocclusion not attempted. At latest follow-up 9/13 (69%) recanalized vessels remained patent and percent flow to affected lung quadrant increased from 7.4 ± 3.4% pre-intervention to 14.3 ± 4.2% (P = 0.004). Mean NYHA Class improved to 1.4 ± 0.4 (P < 0.001).

CONCLUSIONS: Recanalization of total PVO can be accomplished with reasonable mid-term patency, improved symptoms, and lung perfusion. Reocclusion is common, but vessel growth is often observed allowing placement of a reasonably sized stent at a second intervention. Staged intervention is often necessary to maintain patency.