Evaluation of Pulmonary Vein Variations Using  Multidetector Computed Tomography

Mehmet  Demir; Feyza  Gelebek Yılmaz

doi:10.5152/EurJTher.2017.251

Authors

Mehmet Demir Department of Radiology, Gaziantep University School of Medicine https://orcid.org/0000-0002-5031-6324
Feyza Gelebek Yılmaz Department of Radiology, Gaziantep University School of Medicine https://orcid.org/0000-0002-9900-5981

DOI:

https://doi.org/10.5152/EurJTher.2017.251

Keywords:

Pulmonary vein, variation, Multidetector Computed Tomography

Abstract

Objective: In this study, we aimed to identify variations in pulmonary veins (PVs) that are important for preparation before a radiofrequency ablation (RFA) using 64 multidetector computed tomography (MDCT) and to classify their incidence and drainage types.
Methods: In total, 503 patients, including 312 males and 191 females who were examined by abdominal computed tomography angiography for various reasons between January 2011 and December 2016 were included in this study. A 64-section CT device was used for scanning. Two-dimensional multiplanar reformats were created from axial images, and 3-dimensional images were created using maximum intensity projection and volume rendering methods. PV anatomic variations were identified.
Results: A pulmonary venous drainage pattern with the classical pattern, i.e., four ostia with two ostia on the right and two on the left, was observed in 44.8% of the patients. The remaining patients had varying anatomies on the right or on the left. In addition, 3.4% had right top PV, 72.4% had the classical type with two ostia on the right, whereas 27.6% had the varying type with one ostium or more than two ostia on the right. In addition, 61.5% had the classical pattern with two atrial ostia on the left, whereas 38.5% had the varying drainage patterns with one atrial ostium or three atrial ostia on the left. Our study is important in terms of being the largest series to date with 503 patients. The type that involves three separate atrial ostia on the left classified as L3 (Left) is not included in Marom’s classification.
Conclusion: MDCT accurately identifies pulmonary venous anatomy in detail, which is important in RFA preparation.

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References

Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 2004; 230: 824-9.

Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 2003; 107: 2004-10.

Tse HF, Reek S, Timmermans C, Lee KL, Geller JC, Rodriguez LM, et al. Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. J Am Coll Cardiol 2003; 42: 752-8.

Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105: 1077-81.

Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-44.

Niinuma H, George RT, Arbab-Zadeh A, Lima JA, Henrikson CA. Imaging of pulmonary veins during catheter ablation for atrial fibrillation: the role of multi-slice computed tomography. Europace 2008; 10: 14-21.

Lacomis JM, Wigginton W, Fuhrman C, Schwartzman D, Armfield DR, Pealer KM. Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics 2003; 23: 35-48; discussion: 48-50.

Chu ZG, Gao HL, Yang ZG, Yu JQ, Deng W, Wang QL, et al. Pulmonary veins of the patients with atrial fibrillation: dual-source computed tomography evaluation prior to radiofrequency catheter ablation. Int J Cardiol 2011; 148: 245-8.

Liu J, Wu Q, Xu Y, Bai Y, Liu Z, Li H, et al. Role of MDCT angiography in the preoperative evaluation of anomalous pulmonary venous connection associated with complex cardiac abnormality. Eur J Radiol 2012; 81: 1050-6.

Ou P, Marini D, Celermajer DS, Agnoletti G, Vouhe P, Sidi D, et al. Non-invasive assessment of congenital pulmonary vein stenosis in children using cardiac-non-gated CT with 64-slice technology. Eur J Radiol 2009; 70: 595-9.

Leong DP, Delgado V, Bax JJ. Imaging for atrial fibrillation. Curr Probl Cardiol 2012; 37: 7-33.

Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-66.

Kim YH, Marom EM, Herndon JE, McAdams HP. Pulmonary vein diameter, cross-sectional area, and shape: CT analysis. Radiology 2005; 235:43-9; discussion: 9-50.

Tsao HM, Wu MH, Yu WC, Tai CT, Lin YK, Hsieh MH, et al. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001; 12: 1353-7.

Sugimoto S, Izumiyama O, Yamashita A, Baba M, Hasegawa T. Anatomy of inferior pulmonary vein should be clarified in lower lobectomy. Ann Thorac Surg 1998; 66: 1799-800.

Mangrum JM, Mounsey JP, Kok LC, DiMarco JP, Haines DE. Intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins. J Am Coll Cardiol 2002; 39: 1964-72.

Scharf C, Sneider M, Case I, Chugh A, Lai SW, Pelosi F, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. J Cardiovasc Electrophysiol 2003; 14: 150-5.

Weiss C, Willems S, Risius T, Hoffmann M, Ventura R, Meinertz T. Functional disconnection of arrhythmogenic pulmonary veins in patients with paroxysmal atrial fibrillation guided by combined electroanatomical (CARTO) and conventional mapping. J Interv Card Electrophysiol 2002; 6: 267-75.

Chin AJ, Sanders SP, Sherman F, Lang P, Norwood WI, Castaneda AR. Accuracy of subcostal two-dimensional echocardiography in prospective diagnosis of total anomalous pulmonary venous connection. Am Heart J 1987; 113: 1153-9.

Masui T, Seelos KC, Kersting-Sommerhoff BA, Higgins CB. Abnormalities of the pulmonary veins: evaluation with MR imaging and comparison with cardiac angiography and echocardiography. Radiology 1991; 181: 645-9.

Mlcochova H, Tintera J, Porod V, Peichl P, Cihak R, Kautzner J. Magnetic resonance angiography of pulmonary veins: implications for catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol 2005; 28:1073-80.

Cronin P, Kelly AM, Desjardins B, Patel S, Gross BH, Kazerooni EA, et al. Normative analysis of pulmonary vein drainage patterns on multidetector CT with measurements of pulmonary vein ostial diameter and distance to first bifurcation. Acad Radiol 2007; 14: 178-88.

Tse HF, Lee KL, Fan K, Lau CP. Nonfluoroscopic magnetic electroanatomic mapping to facilitate focal pulmonary veins ablation for paroxysmal atrial fibrillation. Pacing Clin Electrophysiology 2002; 25: 57-61.

Tretheway DG, Francis GS, MacNeil DJ, Vieweg WV. Single left pulmonary vein with normal pulmonary venous drainage: a roentgenographic curiosity. Am J Cardiol 1974; 34: 237-9.

Prokop M, Schaefer-Prokop C, Galanski M. Spiral CT angiography of the abdomen. Abdom Imaging 1997; 22: 143-53.

Yazar F, Ozdogmus O, Tuccar E, Bayramoglu A, Ozan H. Drainage patterns of middle lobe vein of right lung: an anatomical study. Eur J Cardiothorac Surg 2002; 22:717-20.

Kaseno K, Tada H, Koyama K, Jingu M, Hiramatsu S, Yokokawa M, et al. Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol 2008; 101, 1638-42.

Lickfett L, Lewalter T, Nickenig G, Naehle P. Common trunk of the right and left inferior pulmonary veins: previously unreported anatomic variant with implications for catheter ablation. Heart Rhythm 2007; 4: 1244-5.

Alfke H, Wagner HJ, Klose KJ. A case of an anomalous pulmonary vein of the right middle lobe. Cardiovasc Intervent Radiol 1995;18: 406-9.

Benfield JR, Gots RE, Mills D. Anomalous single left pulmonary vein mimicking a parenchymal nodule. Chest 1971; 59:101-3.