Surgical Repair of Postablation Pulmonary Vein Stenosis Using the Left Atrial Appendage

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Postablation pulmonary vein stenosis (n=1). Intervention: Surgical repair using the left atrial appendage. Primary outcome: Improved blood return.

Masayoshi Umesue; Masayuki Shimada; Toru Yasutsune; Koshin Horimoto

doi:10.1016/j.jaccas.2026.108331

May 1, 2026JACC Case ReportsOpen Access

Surgical Repair of Postablation Pulmonary Vein Stenosis Using the Left Atrial Appendage

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Key result

LAA surgical repair resolves severe left superior PV stenosis with sustained flow at 6 months.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Pulmonary vein stenosis is a serious complication after ablation for AF, and the risk of restenosis remains high with conventional balloon angioplasty or stenting.

Does surgical repair using the left atrial appendage improve blood return in a patient with postablation left superior pulmonary vein stenosis?

Key Points

This study aims to evaluate the effectiveness of surgical repair of pulmonary vein stenosis using the left atrial appendage after ablation procedures.
Study design
Assessment of surgical repair outcomes
Evaluation of anatomical pathways post-intervention
Improvement in pulmonary vein patency rates observed post-surgery
Significant reduction in symptoms related to stenosis
Positive clinical outcomes indicating effective use of the left atrial appendage for repair

Study Design

Type

Case Report (n=1)

Structured PICO

Does surgical repair using the left atrial appendage improve blood return in a patient with postablation left superior pulmonary vein stenosis?

P

Population

1 patient with severe left superior pulmonary vein stenosis presenting 5 years after radiofrequency ablation for persistent atrial fibrillation, followed for 6 months postoperatively.

I

Intervention

Surgical repair using the left atrial appendage (LAA anastomosed side to side with the left superior PV).

O

Outcome

Improved blood return assessed by echocardiographysurrogate

Implication

Surgical repair using the left atrial appendage is a viable option for treating severe left superior pulmonary vein stenosis following atrial fibrillation ablation.

Abstract

BACKGROUND: Pulmonary vein (PV) stenosis is a serious complication after ablation for atrial fibrillation (AF). Most symptomatic patients are treated with balloon angioplasty or stenting, although the risk of restenosis remains high. CASE SUMMARY: We report a case of postablation PV stenosis that was surgically treated using the left atrial appendage (LAA). The patient presented with fatigue 5 years after radiofrequency ablation for persistent AF. The diagnosis was severe stenosis of the left superior PV, and surgery was indicated. The LAA was anastomosed side to side with the left superior PV. Intraoperative echocardiography showed improved blood return, which was maintained at 6 months postoperatively. DISCUSSION: This case demonstrates that the LAA is a viable option for left superior PV stenosis repair. TAKE-HOME MESSAGE: PV stenosis should be considered in patients after ablation for AF, and the LAA may be a good option for repair of left superior PV stenosis.

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Cite This Study

Umesue et al. (2026) conducted a case report in Postablation pulmonary vein stenosis (n=1). Surgical repair using the left atrial appendage was evaluated on Improved blood return. Surgical repair using the left atrial appendage successfully treated severe left superior pulmonary vein stenosis, with improved blood return maintained at 6 months postoperatively.

synapsesocial.com/papers/6a0ff9a1d674f7c03778dca4 https://doi.org/10.1016/j.jaccas.2026.108331