Thoracoscopic lobectomy for massive hemoptysis caused by complete pulmonary vein occlusion after radiofrequency ablation for atrial fibrillation

Abstract

Complete pulmonary vein occlusion is a rare complication of transcatheter radiofrequency ablation for atrial fibrillation. We here report a 37-year-old man who presented with massive hemoptysis as a result of left superior pulmonary vein occlusion caused by transcatheter radiofrequency ablation for paroxysmal atrial fibrillation. The patient was successfully managed with thoracoscopic left upper lobectomy with a satisfactory outcome. J Thorac Dis 2018;10(4):E296-E300 jtd.amegroups.com stenosis of the left inferior pulmonary vein ( Figure 3C,D). Bronchoscopy showed hyperemic left main and left upper lobe bronchi and severe dilation of submucosal blood vessels (Figure 4). An echocardiogram showed normal pulmonary arterial pressure. The patient was diagnosed as having massive hemoptysis as a result of left superior pulmonary vein occlusion caused by transcatheter radiofrequency ablation on the basis of these findings.Left upper lobectomy was performed by video-assisted thoracoscopy using two ports: a 10-mm port for the camera in the seventh intercostal space and a 40-mm surgical incision in the fourth intercostal space. The left upper lobe was adherent to the chest wall and the mediastinum ( Figure 5A,B). Neovascularization was visible overlying the left upper lobe, hilum, and descending aorta ( Figure 5A,C,D). The mediastinal pleura were incised in the hilar region. Severe adhesion was noted ( Figure 5E). The left superior pulmonary vein was completely obliterated, having been replaced with dense fibrotic tissues. It proved impossible to dissect the left superior pulmonary vein from the left upper lobe bronchus ( Figure 5F) and it was feared that forced isolation might tear the superior pulmonary vein. The proximal branches of the pulmonary artery were difficult to access from the anterior perspective without isolation and division of the superior pulmonary vein. The oblique fissure was therefore dissected to expose the interlobar pulmonary artery and its branches. When they had been identified, the arterial branches to the left upper lobe were divided and the posterior and anterior fissure stapled, leaving the left superior pulmonary vein and left upper lobe bronchus. Finally, an Endo-GIA 45 purple Tri-stapler (Medtronic, Minneapolis, MN, USA) was used to staple both the bronchus and obliterated pulmonary vein. The surgery was successful with intraoperative bleeding of 150 mL and the postoperative course was uneventful, with no complications such as recurrence of hemoptysis or development of a bronchopleural fistula. The patient spent two days in ICU. The chest tube was removed on postoperative Day 5, the daily drainage having been 200 mL, and was discharged on postoperative Day 8 with a normal chest radiograph. Outpatient clinic follow-up was arranged at 2 weeks, 3 months and 6 months after discharge. The patient remained free of symptoms, such as hemoptysis or dyspnea, and recovered well.Histologic examination of hematoxylin and eosin stainedsections demonstrated thrombosis and obliteration of the ...

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“…However, the data on surgical intervention are still scarce, and its benefits over percutaneous intervention are yet to be determined. 7,13 The present case developed a complete occlusion for which catheterization or surgical revascularization is not applicable especially after such a long period of time.…”

Pulmonary Vein Occlusion Requiring Lobectomy after Radiofrequency Catheter Ablation for Atrial Fibrillation: A Case Report and Review of the Literature

“…In such cases, lung resection may be necessary. Reviewing the literature, we have found 11 cases of PVS or PVO after RFA that required lung resection (Table 1) and compared to our case [4,[9][10][11][12][13][14][15][16][17][18]. There was one more case in which lobectomy was attempted, but because of fibrothorax and dense adhesions not performed [19].…”