A 74-year-old man developed complete occlusion of the right superior pulmonary vein presenting as dyspnea on exertion eight months after surgical mitral valve repair.
Case Report (n=1)
This case highlights a rare complication of complete pulmonary vein occlusion following surgical mitral valve repair, emphasizing the need to consider vascular causes for non-specific respiratory symptoms post-operatively.
Abstract Introduction Pulmonary vein stenosis (PVS) is rare in adults, with the most commonly acquired cause being radiofrequency ablation (RFA) for atrial fibrillation. Here, we present a case of right superior pulmonary vein occlusion following surgical mitral valve repair. Case Description A 74-year-old man with a past medical history of Factor V Leiden, recurrent deep vein thromboses on warfarin, and mitral valve prolapse complicated by severe mitral regurgitation presented with eight months of dyspnea on exertion without hypoxemia following surgical mitral valve repair. Chest radiographs demonstrated a right sided infiltrate, resulting in two courses of treatment for presumed community-acquired pneumonia. Transthoracic echocardiography showed mild mitral regurgitation and an appropriately positioned mitral valve annuloplasty ring. Computed tomography (CT) of the chest demonstrated a curvilinear band of subpleural nodular ground glass opacities and consolidation with conspicuous surrounding septal thickening throughout the right upper lobe (Figure 1), raising concern for severe PVS. Cardiac CT angiography confirmed complete occlusion of the right superior pulmonary vein. Discussion PVS presents with non-specific symptoms such as dyspnea, cough, and fatigue and is frequently misdiagnosed as pneumonia, bronchitis, or malignancy. Non-angiographic CT imaging has limited sensitivity, as parenchymal consolidations are seen in only approximately 55% of patients with PVS. A high index of suspicion for PVS is necessary in high-risk patients such as those undergoing RFA for atrial fibrillation. RFA is associated with detectable pulmonary vein narrowing in nearly half of patients and 70% luminal narrowing, or severe PVS, is seen in 0.3-3.4% of patients. To our knowledge, no case reports have been published on pulmonary vein occlusion after surgical mitral valve repair, though right superior PVS has been described after mitral valve surgery. Proposed mechanisms of injury include tension from mechanical traction on the pulmonary veins, cardiopulmonary bypass venting, or inadvertent damage during atriotomy closure. When patients have symptomatic, severe sequelae of PVS such as ventilation/perfusion mismatch, recurrent pulmonary infections, or right heart dysfunction, PVS can be managed with transcatheter stenting, which has improved outcomes compared to balloon angioplasty in post-RFA populations. Data supporting management options for pulmonary vein occlusion are more limited, but surgical patching and lobectomy may be performed for irreversible lung damage. This unique case highlights classic imaging findings of PVS via an atypical etiology and stresses the importance of considering vascular causes of non-specific respiratory symptoms in the appropriate clinical context. This abstract is funded by: None
Zhou et al. (Fri,) conducted a case report in Pulmonary vein occlusion (n=1). Surgical mitral valve repair was evaluated. A 74-year-old man developed complete occlusion of the right superior pulmonary vein presenting as dyspnea on exertion eight months after surgical mitral valve repair.