Successful pulmonary vein occlusion stenting though collateral vessel

A 63-year-old man with a history of paroxysmal atrial fibrillation and symptoms of fatigue and palpitations underwent pulmonary vein isolation 2 years ago. Symptoms improved after the procedure, and he remained in sinus rhythm. However, shortness of breath and haemoptysis developed 6 months after the ablation procedure due to total occlusion of left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV, Panel A). Angiography confirmed the total occlusions and a collateral vessel between LSPV and LIPV (Panels B and C). After recanalization of LSPV (Panel D), angiography indicated the blood flow of LIPV revert to LSPV though collateral channel (Panel E; see Supplementary material online, Movie S1). Antegrade approach for recanalization of LIPV was attempted but failed. Accordingly, retrograde approach was pursued. The collateral channel was used and successfully crossed with a Runthrough wire (TERUMO) and a 135 cm microcatheter (TERUMO) to the occlusion (Panel F). With excellent support, the wire finally passed the occlusion and the whole track (from the left femoral vein to the right femoral vein) was established, followed by antegrade serial balloon dilations (Panel G) to create a common subintimal tract to connect the left atrium and distal LIPV (Panel H). Finally, 10 × 25 mm (diameter × length) bare metal stents (Boston Scientific) were implanted in LIPV (Panel I). Pulmonary vein collateral formation was a long-term result of pulmonary vein stenosis. Retrograde techniques though collateral vessel may increase the rates of success in recanalization. Yan-Jie Li, a medical doctor, is engaged in interventional treatment of cardiology in Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. His main clinical interests are pulmonary vascular disease, congenital heart disease, valvular heart disease, etc. He has been selected into the “Sailing Plan” for young scientific and technological talents of Shanghai Municipal Commission of Science and Technology. Supplementary material is available at European Heart Journal – Case Reports. We acknowledge the contribution from the health care personnel to the patient at Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance. Funding: This work was supported by grants from the Shanghai Committee of Science and Technology, China (17411970900, 18411950400, and 22YF1443000).