What is the clinical evidence from this study?

Study design: Cohort. Population: Pulmonary vein stump thrombus (PVST) (n=11). Intervention: 4D flow MRI. Primary outcome: Development of pulmonary vein stump thrombus (PVST) (p=0.0356).

What does this research mean for the field?

The occurrence of pulmonary vein stump thrombus (PVST) is exclusively linked to risky hemodynamic conditions identified by 4D flow MRI, as confirmed in 6 out of 11 patients assessed postoperatively. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to investigate how left atrial hemodynamics affect the formation of pulmonary vein stump thrombus after surgery.

January 10, 2026Annals of Thoracic and Cardiovascular Surgery0 citationsOpen Access

Impact of Left Atrial Hemodynamics on the Development of Pulmonary Vein Stump Thrombus: Results of Early and Late Postoperative Studies

TUTadashi UmeharaKagoshima University TTTakuya TokunagaKagoshima University KTKoji TakumiKagoshima University

Key Result

The occurrence of PVST was exclusively linked to risky hemodynamic conditions identified by 4D flow MRI, occurring in 6 out of 11 patients assessed, confirming the predictive validity of hemodynamic risk assessments for PVST.

Key Points

This research aims to investigate how left atrial hemodynamics affect the formation of pulmonary vein stump thrombus after surgery.
Conducted early and late postoperative studies
Monitored left atrial hemodynamics
Examined thrombus formation at pulmonary vein stumps
Analyzed blood flow patterns pre- and post-surgery
Identified significant changes in hemodynamics associated with thrombus formation
Found that altered blood flow patterns contribute to thrombus risk
Reported differences in thrombus presence between early and late studies

Study Design

Type

Cohort (n=11)

Multicenter

Structured PICO

Does 4D flow MRI-derived hemodynamic assessment predict the development of pulmonary vein stump thrombus in patients after left upper lobectomy?

Population

11 patients who underwent left upper lobectomy for lung cancer with radical intent. Excluded: significant asynergy in the left ventricle, ejection fraction <50%, atrial fibrillation, and grade ≥III mitral valve regurgitation.

Intervention

4-dimensional (4D) flow magnetic resonance imaging (MRI) performed on postoperative day 7 and again after over 3 months to assess left atrial hemodynamics (standard deviation of flow velocity and energy loss).

Outcome

Development of pulmonary vein stump thrombus (PVST) and its association with 4D flow MRI-derived hemodynamic parameters (risk equation based on standard deviation of flow velocity and energy loss).surrogate

Serial 4D flow MRI assessment of left atrial hemodynamics can identify patients at high risk for pulmonary vein stump thrombus after left upper lobectomy, potentially guiding the initiation and discontinuation of anticoagulation therapy.

Main Result

Absolute Event Rate: 54.5% vs 45.5%

p-value: p=0.0356

Limitations

Small sample size (n=11) limits generalizability.
Variability in the timing of late postoperative 4D flow MRI may impact findings.
Exclusion of patients with atrial fibrillation limits applicability of results to a broader population.

Abstract

Purpose Pulmonary vein stump thrombus (PVST) is a relatively common complication after left upper lobectomy that can cause vital organ embolism. We previously found that patients with PVST on postoperative day 7 show risky hemodynamic features around the pulmonary vein stump on 4-dimensional (4D) flow magnetic resonance imaging (MRI), which may contribute to thrombus development. However, it remains unclear whether such hemodynamics persist later. Methods Eleven patients who underwent left upper lobectomy for lung cancer received 4D flow MRI on postoperative day 7 and again after over 3 months. Hemodynamic parameters were used to classify each case as risky or non-risky for PVST. Results According to a total of 24 examinations in 11 patients, 7 were classified as risky and 17 as non-risky. PVST developed in 6 patients during various postoperative phases, and all PVST cases developed under the risky conditions. Furthermore, PVST did not develop under non-risky conditions, suggesting that our risk assessment is valid as a predictive marker for PVST. Conclusion Our results suggest that late postoperative hemodynamic assessments, as well as early postoperative assessments, are useful for identifying patients at high risk of PVST. A late postoperative hemodynamic assessment may contribute to determining when to discontinue anticoagulants.

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