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Compression of pulmonary veins between the left atrium and the descending aorta

2003; Elsevier BV; Volume: 91; Issue: 2 Linguagem: Inglês

10.1016/s0002-9149(02)03120-x

1879-1913

Clare O’Donnell, James E. Lock, Andrew J. Powell, Stanton B. Perry,

Pulmonary Hypertension Research and Treatments

Typically, pulmonary vein (PV) stenosis is characterized by a concentric, discrete narrowing at the venoatrial junction with variable extension into the lung parenchyma. Compression of PVs, with a significant gradient, has been recognized in patients who develop a giant right atrium after right atrial to pulmonary artery Fontan procedures. 1 Kreutzer J. Keane J.F. Lock J.E. Walsh E.P. Jonas R.A. Castaneda A.R. Mayer Jr, J.E. Conversion of modified Fontan procedure to lateral atrial tunnel cavopulmonary anastomosis. J Thorac Cardiovasc Surg. 1996; 111: 1169-1176 Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar , 2 McElhinney D.B. Reddy V.M. Moore P. Hanley F.L. Revision of previous Fontan connections to extracardiac or intratrial conduit cavopulmonary anastomosis. Ann Thorac Surg. 1996; 62: 1276-1282 Abstract Full Text PDF PubMed Scopus (76) Google Scholar Before 1999, we identified several patients with single ventricle physiology in whom the diagnosis of stenosis of a single PV was missed before undergoing a Fontan procedure. With an increased sensitivity to the diagnosis, we encountered patients with a different type of PV stenosis. These patients had 3 angiographic findings: (1) compression of the lower lobe PV as it crossed anterior to the descending aorta and posterior to the atrium, (2) an uninvolved upper lobe PV, and (3) decreased flow through the pulmonary artery in the affected lobe (Figure 1). Having identified these findings, a literature search revealed that this type of PV compression had recently been described in 4 patients. 3 Kawahira Y. Kadoba K. Matsuda H. Compression of the pulmonary veins by the descending aorta in patients corrected surgically by the Fontan procedure. Cardiol Young. 1998; 8: 86-89 Crossref PubMed Google Scholar Our study was undertaken to better define the incidence, underlying or associated lesions, and clinical significance of PV stenosis of this angiographic type.