心房颤动患者射频消融术后肺静脉狭窄误诊分析

目的提高对心房颤动(房颤)射频消融术后肺静脉狭窄的认识,以早期识别并及时正确治疗。方法回顾性分析2例房颤射频消融术后肺静脉狭窄的临床资料。结果 2例因房颤在外院行射频消融术(肺静脉心房隔离术)。例1术后出现劳累后胸闷、气短,伴鼻分泌物及痰中少量血丝,停用华法林无效,后突然出现左侧胸部锐痛,误诊为胸膜炎;例2术后主要临床表现为咳嗽、胸痛,先后误诊为肺栓塞、肺部感染及真菌性肺炎。2例均经增强多层螺旋CT及心血管三维重建检查确诊肺静脉狭窄,行肺静脉支架置入术,但效果差。结论房颤射频消融术后6～12个月应行增强多层螺旋CT及心血管三维重建或肺通气/灌注扫描检查,以早期发现肺静脉狭窄,避免误诊误治。

Misdiagnosed Analysis of Patients with Atrial Fibrillation and Pulmonary Vein Stenosis after Radio Frequency Current Ablation

Objective To raise awareness of pulmonary vein stenosis after radio frequency current ablation （RFA） for atrial fibrillation in order to identify quickly and perform proper treatalent. Methods Clinical data of 2 patients with pulmonary vein stenosis after radio frequency current ablation （RFA） for atrial fibrillation were retrospectively analyzed. Results 2 patients had undergone radiofrequeney ablation for fibrillation atrial in other hospitals before one patient suffered from dyspnea when being tired, short breath and bad small blood streak in nasal discharge or phlegm after operation. The patient was misdiagnosed as having pleurisy for sudden sharp pain in left side of the chest after stopping using Warfarin ; another had a cough and chest pains and was misdiagnosed as having pulmonary embolism, pulmonary infection and fungal pneumonia after operation. The 2 patients were definitely diagnosed as having pulmonary vein stenosis by reinforcing multislice CT and cadiovascular three-dimensional reconstruction, and underwent stents insertion in puhnonary veins but with poor effect. Conclusion Reinforcing muhislice CT, cadiovascular three-di- mensional reconstruction or lung ventilation/perfusion scan examinations should be performed 6 - 12 months after radio frequency current ablation for atrial fibrillation in order to find pulmonary vein stenosis as early as possible and to avoid misdiagnosis.