Hemodynamic Change in Pulmonary Vein Stenosis after Radiofrequency Ablation: Assessment with Magnetic Resonance Angiography

We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.     

Dual Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varix Draining into the Left Adrenal Vein and Left Inferior Phrenic Vein

A 66-year-old woman with a gastric varix, draining into a dilated left adrenal vein and a left inferior phrenic vein, was treated with dual balloon-occluded retrograde transvenous obliteration (B-RTO). Under balloon occlusion of the left adrenal vein and the left inferior phrenic vein, retrograde injection of a sclerosant (5% ethanolamine oleate) into the gastric varix was performed. Two weeks later, disappearance of flow in the gastric varix was confirmed on endoscopic ultrasound examination.     

Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

Objective

To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization.

Materials and Methods

Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient.

Results

Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix.

Conclusion

Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.     

Successful Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varix Mainly Draining into the Pericardiophrenic Vein

Two cases of gastric varices were treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein at our hospital, and both were successful. One case developed left hydrothorax. Gastric varices did not bled and esophageal varices were not aggravated in both cases for 24–30 months thereafter. These outcomes indicate the feasibility of balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein.     

Transplant Renal Vein Stenosis: Diagnosis and Intervention

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Portal Vein Stenosis Following Liver Transplantation Hemodynamically Assessed with 4D-flow MRI before and after Portal Vein Stenting

We present a case of a patient who underwent portal vein (PV) stenting for PV stenosis after a living-donor liver transplantation. A pretreatment 3D cine phase-contrast (4D-flow) MRI showed decreased, though hepatopetal, blood flow in the PV. After stenting, 4D-flow MRI confirmed an improvement in PV flow, with a more homogeneous flow distribution to each hepatic segment. 4D-flow MRI are valuable for understanding the hemodynamics of this area, planning for treatments, and evaluating the outcome of the interventions.     

Coil Embolization of a Pulmonary Varix via a Transseptal Approach Using Intracardiac Echocardiography

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Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean ± standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg ± 4.6 to 1.1 mmHg ± 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean ± SD follow-up of 134.4 ± 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 ± 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 ± 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.     

肾后段双下腔静脉畸形伴门静脉主干狭窄1例报告

患者　男 ,16岁。 10年前因门静脉高压 ,脾功能亢进 ,巨脾 ,ＩＴＰ而行全脾切除术。 4年前又出现呕血 ,诊断为门静脉高压 ,行肠系膜上静脉与下腔静脉“Ｈ”型搭桥手术 ,植入一直径5ｍｍ人造血管。术后门脉测压下降 12ｍｍＨｇ ,呕血停止。最近2周又开始出现呕血 ,准备再次手术而来我科行血管造影 ,以明确分流口狭窄情况。造影检查 :常规Ｓｅｌｄｉｎｇｅｒ’ｓ氏法行右股动脉穿刺。用 5Ｆ导管行肠系膜上动脉造影 ,静脉期可见肠系膜上静脉 ,门静脉主干清楚显示 ,未见肠系膜上静脉外科干与下腔静脉分流道显影。但外科干至门静脉主干起点上 10…     

经皮单球囊与双球囊肺动脉瓣成形术的对比观察

作者对经皮单球囊肺动脉瓣成形术１７例和双球囊扩张４０例的效果进行比较。扩张前两组右室收缩压分别为１１．７６±３．９４ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）与１２．６１±４．３３ｋＰａ；跨瓣压差分别为８．１１±３．６８ｋＰａ与８．４０±４．６１ｋＰａ（Ｐ＞０．０５）。扩张后右室收缩压分别为６．４８±１．６６ｋＰａ与７．０５±３．４４ｋＰａ；跨瓣压差分别为２．０１±１．５１ｋＰａ与２．１５±１．７８ｋＰａ（Ｐ＞０．０５）。上述结果提示单球囊与双球囊扩张的效果相同。     

肺动脉瓣狭窄合并动脉导管未闭的超声诊断

目的:探讨肺动脉瓣狭窄(PS)合并动脉导管未闭(PDA)的超声诊断方法。材料和方法:超声测量16例PS+PDA及16例单纯PS患儿的主动脉瓣口峰值流速(Vp),平均流速(Vm)及流速时间积分(VTI)。除常规在胸骨旁短轴切面扫查外,应用二维、彩色及脉冲多普勒于胸骨旁肺动脉分叉切面,胸骨上主动脉弓长轴切面以及剑突下短轴切面探查PDA。结果:16例PS+PDA患儿检出PDA12例,漏诊4例。PS+PDA的主动脉瓣口Vp略高于单纯PS患者。结论:探查PS患儿胸骨旁肺动脉分叉切面,胸骨上主动脉弓长轴切面以及剑突下短轴切面有助于发现PDA。PS患儿主动脉瓣口Vp增高时提示可能存在PDA。     

副肺静脉的多层螺旋CT研究

目的 采用多层螺旋CT研究副肺静脉的出现率与解剖特点.资料与方法 回顾分析120例非房颤患者冠状动脉CTA资料,综合三维容积重组(VR)、多平面重组(MPR)及原始横断面图像,观察有无副肺静脉、副肺静脉出现部位、副肺静脉引流肺叶;计算副肺静脉出现率是否存在性别差异.采用血管分析软件测量副肺静脉口部短径、长径、面积及指数(短径/长径).结果 120例中有19例出现23条副肺静脉,出现率为15.8%;男性出现率为17.4%,女性为13.7%,经x2检验,x2=3.7253,P＞0.05,两者差异无统计学意义.18条出现在右肺上、下静脉之间,其中10条引流右肺中叶外侧段,6条引流右肺中叶内侧段,1条引流右肺下叶背段,1条引流右肺下叶后基底段;2条出现在左肺上、下静脉之间,均引流左肺上叶下舌段;3条出现在左心房上壁双上肺静脉之间,均引流右肺上叶后段.副肺静脉在右侧出现的概率较大.副肺静脉口部长径为(10.13±4.05)mm,短径为(7.14±2.s4)mm,面积为(68.64±55.24)mm2,口部指数为0.71±0.12.结论 多层螺旋CT能显示副肺静脉解剖细节与特点,对研究副肺静脉有一定价值.     

小儿先天性心脏病肺动脉狭窄的影像学对照研究

笔者应用盲法测定１６例小儿肺动脉狭窄磁共振成像、超声心动图和心血管造影图像上右室流出道和肺动脉的宽度，经相关回归分析发现：磁共振成像同心血管造影测量值相关性最好，而超声心动图同心血管造影仅在右室流出道和肺动脉主干宽度上具良好相关。结果表明，磁共振成像作为一种无创性技术，可代替或部分取代心血管造影来评价肺动脉发育状况。     

多层螺旋CT对肺静脉的影像学评价

近年来,研究表明大部分阵发性房颤起源于肺静脉,肺静脉变异如一侧肺静脉共干及独立肺静脉是房颤异位起搏重要来源[1～3];肺静脉心肌袖在房颤触发和驱动中起着重要作用[4].应用多层螺旋CT对肺静脉进行影像学评价,已引起一些研究者的重视.     

Lung Infarction due to Pulmonary Vein Stenosis after Ablation Therapy for Atrial Fibrillation Misdiagnosed as Organizing Pneumonia: Sequential Changes on CT in Two Cases

Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.     

The Hunter Pulmonary Angiography Catheter for a Brachiocephalic Vein Approach

The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a "C-shaped" curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk.