Background
Pulmonary vein (PV) stenosis is a rare complication after catheter ablation for atrial fibrillation (AF). While there have been reported anecdotal cases of complete PV stenosis requiring pulmonary lobectomy, only one case of pneumonectomy have been documented so far.
Case summary
A 42-years old man was referred to our Thoracic Surgery Unit for recurrent haemoptysis and exertional dyspnoea over the past four years, and a recent finding of left PVs occlusion. He suffered of relapsing atrial fibrillation that had almost five recurrences and that underwent a total of two percutaneous catheter ablations within a seven-year period. He also experienced a hospitalization for multifocal lobar pneumonia. Two attempts of percutaneous balloon angioplasty (PTA) were unsuccessful. Due to the severity and the duration of PVs occlusion, the previous PTA failure, the patient’s age, and his symptoms, a left pneumonectomy was performed. During the postoperative period, the patient experienced only mild anaemia effectively managed with blood transfusions. Five months after surgery, he has no recurrence of symptoms.
Discussion
When the PV stenosis is complete, PTA may face high failure and recurrence rates. In this setting, anatomical pulmonary resections may represent a valid option to allow symptoms relief and resolution.