Aa
Pulmonary Vein Stenosis
Steel mesh stents seems to be the most recommended procedure for treatment of acquired PV Stenosis post op RF ablation however there is a high occurence of restonsis requireing dialation 3 to 6 months later and possibly again in another 3 to 6 months. Can you comment on other procedures that are available and their success?
Thank you, Ed W
Thank you, Ed W
I am 35 years old, pretty fit and active, and had an ablation, actually 2, in 2002 at DUMC - Dr. Wharton for chronic AFib. I had this condition for 10 years and had failed all families of drugs to control - the last being a combination of Amiodarone and Flecainide.
The procedures were a success for the Afib, but let me with 2 stenosed PV's on the left side. The decision was made to stent and restenosis occured 3 times following requiring angioplasty. The main sympton was severe chest pain.
About 6 months ago I started feeling similar chest pain and my Dr's at Duke performed a CT angiogram and showed 100% stenosis in the upper PV and ~ 50% in the lower. Later that week these findings were confirmed with a cath to check pressures in my lungs. The PV's were not re-opened for fear of causing more stenosis of the lower PV. This was the 6th time the transseptal had been performed.
About 3 weeks ago I had an episode of A-fib and had to be cardioverted to resolve. It re-occured this week requiring another cardioversion and Flecainide to control.
My cardiologist and I have discussed the possibility of another ablation possibly cryo-ablation - Dr. Frazier at Pitt Memorial in Greenville NC.
My question is do you have any infomation on the long term prognisis of PV stenosis and the risk of further stenosis if I choose to have another ablation - cryo or RF.
The procedures were a success for the Afib, but let me with 2 stenosed PV's on the left side. The decision was made to stent and restenosis occured 3 times following requiring angioplasty. The main sympton was severe chest pain.
About 6 months ago I started feeling similar chest pain and my Dr's at Duke performed a CT angiogram and showed 100% stenosis in the upper PV and ~ 50% in the lower. Later that week these findings were confirmed with a cath to check pressures in my lungs. The PV's were not re-opened for fear of causing more stenosis of the lower PV. This was the 6th time the transseptal had been performed.
About 3 weeks ago I had an episode of A-fib and had to be cardioverted to resolve. It re-occured this week requiring another cardioversion and Flecainide to control.
My cardiologist and I have discussed the possibility of another ablation possibly cryo-ablation - Dr. Frazier at Pitt Memorial in Greenville NC.
My question is do you have any infomation on the long term prognisis of PV stenosis and the risk of further stenosis if I choose to have another ablation - cryo or RF.
MEDICAL PROFESSIONAL
I can tell you what we did when I was in Cleveland -- fortunately, PV stenosis isn't as common anymore.
We would do balloon dilation with out a stent. I agree that the stent carries a risk of restenosis and I don't think there is a study to suggest that is better than balloon dilation without stent. The biggest problem now is a paucity of randomized trial to answer the question directly. I would strongly recommend that if you are having this procedure, that it be done by a very experienced operator at a very experienced center.
Your question is a very good one, the answers are just not there yet. I just did a medline search and could not find literature to quote the recurrence rate of restenosis.
I hope this helps.
We would do balloon dilation with out a stent. I agree that the stent carries a risk of restenosis and I don't think there is a study to suggest that is better than balloon dilation without stent. The biggest problem now is a paucity of randomized trial to answer the question directly. I would strongly recommend that if you are having this procedure, that it be done by a very experienced operator at a very experienced center.
Your question is a very good one, the answers are just not there yet. I just did a medline search and could not find literature to quote the recurrence rate of restenosis.
I hope this helps.
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