Relentless pulmonary vein stenosis: A contemporary approach to a recurring problem

Fusion Imaging for Procedural Guidance

The field of percutaneous structural heart interventions has grown tremendously in recent years. This growth has fueled the development of new imaging protocols and technologies in parallel to help facilitate these minimally-invasive procedures. Fusion imaging is an exciting new technology that combines the strength of 2 imaging modalities and has the potential to improve procedural planning and the safety of many commonly performed transcatheter procedures. In this review we discuss the basic concepts of fusion imaging along with the relative strengths and weaknesses of static vs dynamic fusion imaging modalities. This review will focus primarily on echocardiographic-fluoroscopic fusion imaging and its application in commonly performed transcatheter structural heart procedures.

Emergency Covered Stent Implantation For Rupture Of A Pulmonary Vein After Balloon Angioplasty For Postinterventional Pulmonary Vein Stenosis

Pulmonary vein (PV) stenosis is a known complication of PV isolation procedures for atrial fibrillation. We describe in this report a case of emergency covered stent implantation for rupture of a PV after balloon angioplasty for postinterventional PV stenosis occlusion. Focus is on stent implantation and on a novel aspect of magnetic resonance imaging for postprocedural outcome evaluation. A focused review of the current literature regarding ongoing limitations of PV stenosis treatment is provided.

Intravascular pulmonary venous ultrasound imaging for catheter ablation of atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia. The development of electroanatomical mapping is an increase demand for advanced intracardiac imaging techniques of the left atrium and pulmonary veins. IVUS can demonstrate quantitative changes like lumen and wall thickness as well as qualitative changes of the pulmonary wall. IVUS could also provide relevant real time imaging of the atrial and pulmonary venous wall during catheter ablation. Areas covered: The Medline and Embase databases were searched for preclinical and clinical studies of IVUS in patients with ablation of atrial fibrillation or left atrial arrhythmias. This article reviews the 15 years of preclinical and clinical experience with IVUS evaluating the pulmonary veins. Expert commentary: IVUS has proven to be a valuable imaging technique in the management of atrial fibrillation ablation. The understanding of the relation between morphological changes and functional results of catheter ablation, combined with the safety profile have made it appealing for interventionists.