Pulmonary vein (PV) isolation is increasingly done for treatment of atrial fibrillation (AF). However there is paucity of studies of the morphology of PV by echo imaging.
MATERIAL & METHODS:
Right upper (RUPV) and left upper (LUPV) pulmonary veins were evaluated with transesophageal echo (TEE) in two orthogonal longitudinal planes (coronal and sagittal). Due to difficulties of obtaining orthogonal views, inferior PVs were excluded. PV diameter was measured at ostial site and 1 cm away from ostium in body of PV. Diameter was measured for each PV in systole, diastole and during atrial reversal (if in sinus rhythm).
45 PVs (RUPV 17, LUPV 28) from 36 patients were studied (32 male, 4 female). Rhythm was sinus in 25 pts, AF in 10 and paced in 1. For both RUPV & LUPV, ostial diameters were different in two orthogonal planes (RUPV 16 ± 4 mm vs. 20 ± 5 mm, p<0.002; LUPV 14 ± 3 mm vs 18 ± 4 mm, p<0.0001). For RUPV the largest of the orthogonal diameters was in coronal plane in 6 pts and sagittal plane in 11. For LUPV the largest of orthogonal diameters was in coronal plane in 19 pts and sagittal plane in 9 pts. Significant difference in orthogonal views was also seen in LUPV diameter 1 cm away from ostium (13 ± 4 mm vs 15 ± 4 mm, p<0.01), but not in RUPV. No differences were seen between RUPV or LUPV diameters obtained during systole, diastole and atrial reversal phases.
1. Both RUPV and LUPV ostia are asymmetrical (oval shaped) with a larger and a smaller diameter. 2.This difference in diameters is maintained in LUPV at 1 cm from ostial site, but not in RUPV. 3. No significant differences in diameter are seen during different periods of cardiac cycle. 4. PV diameter should be routinely measured in two orthogonal planes since size of PV ostia has impact on selection of catheters for PV isolation.
C.A. Sivaram, None.