Request an Appointment



Contact us with Questions

Expand Content

Pulmonary Vein Stenting

Case Study: Pulmonary vein stenting for stenosis following pulmonary vein isolation for atrial fibrillation

Amar Krishnaswamy, MD, E. Murat Tuzcu, MD, Bryan Baranowski, MD, and Samir R. Kapadia, MD


A 25-year-old man had been diagnosed with symptomatic atrial fibrillation and prescribed antiarrhythmic medications. Due to inadequate rate and rhythm control, he was referred for pulmonary vein isolation (PVI) at another institution. Within a few weeks of the procedure, he experienced the onset of cough, mild left-sided chest discomfort and worsening dyspnea. He presented to Cleveland Clinic for further evaluation and management.

Click on images for a larger view

Figure a Figure b Figure c Figure d


Chest X-ray was unremarkable. However, a CT scan of the chest demonstrated complete occlusion of the left superior pulmonary vein (LSPV, Figure 1A). A nuclear perfusion scan of the lungs demonstrated a marked reduction in perfusion to the left upper lung field, concurrent with reduced drainage of the left upper lung due to the LSPV occlusion. Given the patient’s significant symptoms, the decision was made to treat the LSPV occlusion percutaneously.


The patient was brought to the cardiac catheterization laboratory. After sterile preparation and administration of local anesthesia and conscious sedation, venous access was obtained in the left femoral vein. An intracardiac echocardiography probe was introduced and advanced into the right atrium to facilitate transseptal puncture from the right atrium to the left atrium. Via access in the right femoral vein, a transseptal puncture needle was passed and advanced to the left atrium. An angiogram of the left atrium demonstrated subtotal occlusion of the LSPV (Figure 1B). A wire was passed through the occlusion into the LSPV branches. A drug-eluting stent was then placed in the ostium of the LSPV, yielding complete patency of the vessel (Figure 1C). Follow-up CT scan demonstrated patency of the LSPV stent (Figure 1D). At 1-year follow-up, the patient remained free of his presenting symptoms.


Severe pulmonary vein stenosis (PVS) is seen in 1-2 percent of patients after PVI. Although contemporary PVI techniques have substantially reduced the incidence of this complication, vigilance in diagnosing PVS is important. We recommend routine CT scanning of the pulmonary veins 3-4 months after PVI as surveillance.

Symptomatic pulmonary vein stenosis may present with coughing, hemoptysis, and/or dyspnea. In this setting, treatment is beneficial for symptom relief. In patients with severe but asymptomatic PV stenosis, the role of treatment is unclear. In patients who are asymptomatic, but demonstrate significant perfusion defect on nuclear scanning, treatment may still be reasonable. Up to 10 percent of patients with a moderate degree of stenosis on CT scanning at 3-month follow-up may develop worsening stenosis by 6-12 month follow-up and should be subsequently evaluated.

Reviewed: 01/14

Non-critical demographic information has been changed to protect the anonymity of the individual and no association with any actual patient is intended or should be inferred.

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

Schedule an Appointment

Toll-free 800.659.7822

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

HealthHub from Cleveland Clinic

Read the Latest from Our Experts About cctopics » Heart & Vascular Health
High Blood Pressure? Don’t Take Vitamin D for It (Video)
11/20/14 8:31 a.m.
Sellers of vitamin D claim the nutrient can lower your blood pressure. But don’t believe the hype. Despite claims from the nutrition industry and non-medical personnel abou...
by Steven Nissen, MD
When Your Heart Stents Narrow, Brachytherapy Can Help
11/19/14 8:22 a.m.
Cardiac stents are an effective, nonsurgical way of holding a narrowed or blocked artery open to increase blood...
A Post ER Follow-Up Could Save Your Life
11/17/14 8:39 a.m.
Even if Emergency Room doctors say you didn’t actually have a heart attack, that doesn’t mean you h...
Recipe: Low-Fat Crunchy Pumpkin Pie
11/14/14 7:00 a.m.
This low-fat crunchy pumpkin pie uses only a small amount of oil in the crust and skim milk in the filling to m...
Varicose Veins: Not Just an Older Woman’s Problem
11/13/14 8:13 a.m.
You might think of varicose veins as an older woman’s problem, but it may actually have more to do with your li...