Laser balloon ablation in patients with a left common pulmonary vein.

Background: Pulmonary vein isolation (PVI) with a balloon-based visually guided laser ablation (VGLA) is regarded as a useful therapeutic tool for treating atrial fibrillation (AF). The clinical efficacy of a VGLA has never been fully investigated in patients with a left common pulmonary vein (LCPV). Objective: We investigated the procedural safety as well as clinical usefulness of VGLA in patients with an LCPV. Methods: This study consisted of 130 consecutive patients who underwent VGLA of de novo non-valvular paroxysmal AF. Results: Eleven patients (8.5%) had an LCPV (ostium maximal average diameter: 27.5 ± 4.9 mm, ostium minimal average diameter: 17.7 ± 3.5 mm). Nine out of 11 (81.8%) LCPVs were successfully occluded and isolated at the ostium with a VGLA guided PVI. The ablation procedure time was significantly shorter in the patients with than without an LCPV (61.5 ± 15.4 vs. 86.9 ± 32.9 min, p = 0.01). There was no difference regarding the atrial tachyarrhythmia recurrence between those with and without an LCPV (p = 0.18). A total of fifteen patients underwent a redo procedure, but reconnections were not observed in any of the LCPV patients. Conclusion: The VGLA guided PVI was a useful therapeutic tool even in patients with an LCPV. The presence of an LCPV was not associated with any atrial tachyarrhythmia recurrence.

Common pulmonary vein atresia

A 4-hour-old infant with profound cyanosis on an alprostadil infusion was urgently transferred to Rady Children’s Hospital with suspected CHD. Upon arrival, urgent echocardiography was performed but could not confirm the presence of discrete pulmonary veins or pulmonary venous drainage. Given the difficulty in delineating the anatomy, a cardiac CT scan was performed and demonstrated a nearly atretic common pulmonary vein with multiple small collaterals that drained to systemic veins. Due to the high risk of mortality associated with operative repair, the decision was made to proceed with compassionate withdrawal of care. The described anatomy of common pulmonary vein atresia remains rare, and to our knowledge, fewer than 40 cases have been reported in the literature. Albeit rare, common pulmonary vein atresia should be considered in the differential diagnosis of a severely cyanotic neonate.

Esophageal compression by a common left pulmonary venous trunk

Dysphagia is a symptom with diverse etiologies including luminal narrowing of the esophagus and motility disorders. Arterial vessels are known to compress the esophagus and cause luminal narrowing. However, identifying a pulmonary venous compression of the esophagus rarely occurs in a patient with dysphagia. The technology available at the time of the few prior case reports published more than three decades ago limited the analysis of the pulmonary vessels. We report a case that utilized CT-angiography as well as multiplanar reconstructions and three-dimensional imaging to demonstrate that esophageal compression in the patient presenting with dysphagia was caused by a large left common pulmonary vein.