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Erschienen in: Wiener klinische Wochenschrift 19-20/2019

12.06.2019 | original article

Evaluation of pulmonary venous variations in a large cohort

Multidetector computed tomography study with new variations

verfasst von: Derya Altinkaynak, MD, Asli Koktener, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 19-20/2019

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Summary

Objective

The aim of this study was to assess pulmonary venous anatomy and to determine the frequency of each drainage pattern in a large cohort using multidetector computed tomography (MDCT) and three-dimensional (3D) imaging.

Material and methods

The chest CT images of 550 patients were retrospectively reviewed for pulmonary venous anatomy and variant patterns. All CT scans were performed using a 128 detectors row CT scanner after intravenous contrast administration. Pulmonary venous drainage pattern was documented for each patient and frequency of each drainage type was calculated. A useful classification system was used to simplify complex pulmonary venous anatomy.

Results

The expected typical anatomy was observed in 239 (43.5%) patients. The remaining 311 (56.5%) patients had anatomic variations on the right, left, or both sides. The most common variation was left common vein, seen in 177 (32.2%) patients, followed by accessory right middle lobe vein(s), seen in 112 (20.4%) patients. In the present study the frequency of variant anatomy on the right (34%) and left (33.3%) sides were similar.

Conclusion

The use of MDCT with 3D imaging is a preferable imaging tool for demonstrating pulmonary venous anatomy in detail, which shows significant variability. Considering the high prevalence of variations in the population, performing preprocedural MDCT may facilitate higher success rates in radiofrequency catheter ablation (RFCA) and help to perform safe and accurate surgery especially in video-assisted thoracic surgery (VATS).
Literatur
1.
Zurück zum Zitat Jaïs P, Haïssaguerre M, Shah DC, et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation. 1997;95(3):572–6.PubMed Jaïs P, Haïssaguerre M, Shah DC, et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation. 1997;95(3):572–6.PubMed
2.
Zurück zum Zitat Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.PubMed Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.PubMed
3.
Zurück zum Zitat Tsao HM, Wu MH, Yu WC, et al. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2001;12(12):1353–7.PubMed Tsao HM, Wu MH, Yu WC, et al. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2001;12(12):1353–7.PubMed
4.
Zurück zum Zitat Cronin P, Sneider MB, Kazerooni EA, et al. MDCT of the left atrium and pulmonary veins in planning radiofrequency catheter ablation for atrial fibrillation: a how to guide. AJR Am J Roentgenol. 2004;183(3):767–78.PubMed Cronin P, Sneider MB, Kazerooni EA, et al. MDCT of the left atrium and pulmonary veins in planning radiofrequency catheter ablation for atrial fibrillation: a how to guide. AJR Am J Roentgenol. 2004;183(3):767–78.PubMed
5.
Zurück zum Zitat Stojanovska J, Cronin P. CT imaging of left atrium and pulmonary veins for radiofrequency ablation of atrial fibrillation. Semin Roentgenol. 2008;43(2):154–66.PubMed Stojanovska J, Cronin P. CT imaging of left atrium and pulmonary veins for radiofrequency ablation of atrial fibrillation. Semin Roentgenol. 2008;43(2):154–66.PubMed
6.
Zurück zum Zitat Asai K, Urabe N, Yajima K, Suzuki K, Kazui T. Right upper lobe venous drainage posterior to the bronchus intermedius: preoperative identification by computed tomography. Ann Thorac Surg. 2005;79(6):1866–71.PubMed Asai K, Urabe N, Yajima K, Suzuki K, Kazui T. Right upper lobe venous drainage posterior to the bronchus intermedius: preoperative identification by computed tomography. Ann Thorac Surg. 2005;79(6):1866–71.PubMed
7.
Zurück zum Zitat Yamada S, Suga A, Inoue Y, Iwazaki M. Importance of preoperative assessment of pulmonary venous anomaly for safe video-assisted lobectomy. Interact Cardiovasc Thorac Surg. 2010;10(6):851–4.PubMed Yamada S, Suga A, Inoue Y, Iwazaki M. Importance of preoperative assessment of pulmonary venous anomaly for safe video-assisted lobectomy. Interact Cardiovasc Thorac Surg. 2010;10(6):851–4.PubMed
8.
Zurück zum Zitat Matsumoto I, Ohta Y, Tsunezuka Y, et al. A surgical case of lung cancer in a patient with the left superior and inferior pulmonary veins forming a common trunk. Ann Thorac Cardiovasc Surg. 2005;11(5):316–9.PubMed Matsumoto I, Ohta Y, Tsunezuka Y, et al. A surgical case of lung cancer in a  patient with the left superior and inferior pulmonary veins forming a common trunk. Ann Thorac Cardiovasc Surg. 2005;11(5):316–9.PubMed
9.
Zurück zum Zitat Nakamura T, Koide M, Nakamura H, Toyoda F. The common trunk of the left pulmonary vein injured incidentally during lung cancer surgery. Ann Thorac Surg. 2009;87(3):954–5.PubMed Nakamura T, Koide M, Nakamura H, Toyoda F. The common trunk of the left pulmonary vein injured incidentally during lung cancer surgery. Ann Thorac Surg. 2009;87(3):954–5.PubMed
10.
Zurück zum Zitat Akiba T, Marushima H, Odaka M, Harada J, Kobayashi S, Morikawa T. Pulmonary vein analysis using three dimensional computed tomography angiography for thoracic surgery. Gen Thorac Cardiovasc Surg. 2010;58(7):331–5.PubMed Akiba T, Marushima H, Odaka M, Harada J, Kobayashi S, Morikawa T. Pulmonary vein analysis using three dimensional computed tomography angiography for thoracic surgery. Gen Thorac Cardiovasc Surg. 2010;58(7):331–5.PubMed
11.
Zurück zum Zitat Alfke H, Wagner HJ, Klose KJ. A case of an anomalous pulmonary vein of the right middle lobe. Cardiovasc Intervent Radiol. 1995;18(6):406–9.PubMed Alfke H, Wagner HJ, Klose KJ. A case of an anomalous pulmonary vein of the right middle lobe. Cardiovasc Intervent Radiol. 1995;18(6):406–9.PubMed
12.
Zurück zum Zitat Collins DR, Shea PM, Vieweg WV. Idiopathic prominence of pulmonary veins on chest x‑ray. Angiology. 1982;33(9):613–6.PubMed Collins DR, Shea PM, Vieweg WV. Idiopathic prominence of pulmonary veins on chest x‑ray. Angiology. 1982;33(9):613–6.PubMed
13.
Zurück zum Zitat Benfield JR, Gots RE, Mills D. Anomalous single left pulmonary vein mimicking a parenchymal nodule. Chest. 1971;59(1):101–3.PubMed Benfield JR, Gots RE, Mills D. Anomalous single left pulmonary vein mimicking a parenchymal nodule. Chest. 1971;59(1):101–3.PubMed
14.
Zurück zum Zitat Hasuo K, Numaguchi Y, Kishikawa T, Ikeda J, Matsuura K. Anomalous unilateral single pulmonary vein mimicking pulmonary varices. Chest. 1981;79(5):602–4.PubMed Hasuo K, Numaguchi Y, Kishikawa T, Ikeda J, Matsuura K. Anomalous unilateral single pulmonary vein mimicking pulmonary varices. Chest. 1981;79(5):602–4.PubMed
15.
Zurück zum Zitat 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(2):237–9.PubMed 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(2):237–9.PubMed
16.
Zurück zum Zitat Rey C, Vaksmann G, Francart C. Anomalous unilateral single pulmonary vein mimicking partial anomalous pulmonary venous return. Cathet Cardiovasc Diagn. 1986;12(5):330–3.PubMed Rey C, Vaksmann G, Francart C. Anomalous unilateral single pulmonary vein mimicking partial anomalous pulmonary venous return. Cathet Cardiovasc Diagn. 1986;12(5):330–3.PubMed
17.
Zurück zum Zitat Ghaye B, Szapiro D, Dacher JN, et al. Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. Radiographics. 2003;23(Spec No):S19–S33. discussion S48–50.PubMed Ghaye B, Szapiro D, Dacher JN, et al. Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. Radiographics. 2003;23(Spec No):S19–S33. discussion S48–50.PubMed
18.
Zurück zum Zitat Kato R, Lickfett L, Meininger 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(15):2004–10.PubMed Kato R, Lickfett L, Meininger 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(15):2004–10.PubMed
19.
Zurück zum Zitat Mansour M, Holmvang G, Sosnovik D, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(4):387–93.PubMed Mansour M, Holmvang G, Sosnovik D, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(4):387–93.PubMed
20.
Zurück zum Zitat Lickfett L, Dickfeld T, Kato R, et al. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol. 2005;16(6):582–8.PubMed Lickfett L, Dickfeld T, Kato R, et al. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol. 2005;16(6):582–8.PubMed
21.
Zurück zum Zitat Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230(3):824–9.PubMed Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230(3):824–9.PubMed
22.
Zurück zum Zitat Sherif HM. The developing pulmonary veins and left atrium: implications for ablation strategy for atrial fibrillation. Eur J Cardiothorac Surg. 2013;44(5):792–9.PubMed Sherif HM. The developing pulmonary veins and left atrium: implications for ablation strategy for atrial fibrillation. Eur J Cardiothorac Surg. 2013;44(5):792–9.PubMed
23.
Zurück zum Zitat Hassani C, Saremi F. Comprehensive cross-sectional imaging of the pulmonary veins. Radiographics. 2017;37(7):1928–54.PubMed Hassani C, Saremi F. Comprehensive cross-sectional imaging of the pulmonary veins. Radiographics. 2017;37(7):1928–54.PubMed
24.
Zurück zum Zitat Shukla L, Neha G, Soni G, Dhall V. Variations in the number of drainage pattern of pulmonary veins draining into left atrium. J Anat Soc India. 2012;61(1):5–8. Shukla L, Neha G, Soni G, Dhall V. Variations in the number of drainage pattern of pulmonary veins draining into left atrium. J Anat Soc India. 2012;61(1):5–8.
25.
Zurück zum Zitat D’Souza AS, Bhat KM. Variations in the pulmonary venous ostium in the left atrium and its clinical importance. J Clin Diagn Res. 2014;8(2):10–1.PubMedPubMedCentral D’Souza AS, Bhat KM. Variations in the pulmonary venous ostium in the left atrium and its clinical importance. J Clin Diagn Res. 2014;8(2):10–1.PubMedPubMedCentral
26.
Zurück zum Zitat Thorning C, Hamady M, Liaw JV, et al. CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin Imaging. 2011;35(1):1–9.PubMed Thorning C, Hamady M, Liaw JV, et al. CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin Imaging. 2011;35(1):1–9.PubMed
27.
Zurück zum Zitat Harbi A, Mhish H, Alshehri HZ, Das KM. Anatomical variation of pulmonary venous ostium and its relationship with atrial arrhythmia in the Saudi population. J Saudi Heart Assoc. 2014;26(2):81–5.PubMed Harbi A, Mhish H, Alshehri HZ, Das KM. Anatomical variation of pulmonary venous ostium and its relationship with atrial arrhythmia in the Saudi population. J Saudi Heart Assoc. 2014;26(2):81–5.PubMed
28.
Zurück zum Zitat Kaseno K, Tada H, Koyama K, 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(11):1638–42.PubMed Kaseno K, Tada H, Koyama K, 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(11):1638–42.PubMed
29.
Zurück zum Zitat Hamdan A, Charalampos K, Roettgen R, et al. Magnetic resonance imaging versus computed tomography for characterization of pulmonary vein morphology before radiofrequency catheter ablation of atrial fibrillation. Am J Cardiol. 2009;104(11):1540–6.PubMed Hamdan A, Charalampos K, Roettgen R, et al. Magnetic resonance imaging versus computed tomography for characterization of pulmonary vein morphology before radiofrequency catheter ablation of atrial fibrillation. Am J Cardiol. 2009;104(11):1540–6.PubMed
30.
Zurück zum Zitat Anselmino M, Blandino A, Beninati S, et al. Morphologic analysis of left atrial anatomy by magnetic resonance angiography in patients with atrial fibrillation: a large single center experience. J Cardiovasc Electrophysiol. 2011;22(1):1–7.PubMed Anselmino M, Blandino A, Beninati S, et al. Morphologic analysis of left atrial anatomy by magnetic resonance angiography in patients with atrial fibrillation: a large single center experience. J Cardiovasc Electrophysiol. 2011;22(1):1–7.PubMed
31.
Zurück zum Zitat Wannasopha Y, Oilmungmool N, Euathrongchit J. Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study. Biomed Imaging Interv J. 2012;8(1):e4.PubMedPubMedCentral Wannasopha Y, Oilmungmool N, Euathrongchit J. Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study. Biomed Imaging Interv J. 2012;8(1):e4.PubMedPubMedCentral
32.
Zurück zum Zitat 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(5):717–20.PubMed 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(5):717–20.PubMed
33.
Zurück zum Zitat Wang W, Buehler D, Hamzei A, Wang XN, Yuan XH. Comprehensive surgical approach to treat atrial fibrillation in patients with variant pulmonary venous anatomy. J Thorac Cardiovasc Surg. 2013;145(3):790–5.PubMed Wang W, Buehler D, Hamzei A, Wang XN, Yuan XH. Comprehensive surgical approach to treat atrial fibrillation in patients with variant pulmonary venous anatomy. J Thorac Cardiovasc Surg. 2013;145(3):790–5.PubMed
34.
Zurück zum Zitat Tekbas G, Gumus H, Onder H, et al. Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography. Wien Klin Wochenschr. 2012;124(1–2):3–10.PubMed Tekbas G, Gumus H, Onder H, et al. Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography. Wien Klin Wochenschr. 2012;124(1–2):3–10.PubMed
35.
Zurück zum Zitat Vonken EPA, Velthuis BK, Wittkampf FH, Rensing BJ, Derksen R, Cramer MJM. Contrast-enhanced MRA and 3D visualization of pulmonary venous anatomy to assist radiofrequency catheter ablation. J Cardiovasc Magn Reson. 2003;5(4):545–51.PubMed Vonken EPA, Velthuis BK, Wittkampf FH, Rensing BJ, Derksen R, Cramer MJM. Contrast-enhanced MRA and 3D visualization of pulmonary venous anatomy to assist radiofrequency catheter ablation. J Cardiovasc Magn Reson. 2003;5(4):545–51.PubMed
36.
Zurück zum Zitat Schwartzman D, Lacomis J, Wigginton WG. Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography. J Am Coll Cardiol. 2003;41(8):1349–57.PubMed Schwartzman D, Lacomis J, Wigginton WG. Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography. J Am Coll Cardiol. 2003;41(8):1349–57.PubMed
37.
Zurück zum Zitat Jongbloed MR, Bax JJ, Lamb HJ, et al. Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2005;45(3):343–50.PubMed Jongbloed MR, Bax JJ, Lamb HJ, et al. Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2005;45(3):343–50.PubMed
38.
Zurück zum Zitat Benini K, Marini M, Del Greco M, Nollo G, Manera V, Centonze M. Role of multidetector computed tomography in the anatomical definition of the left atrium-pulmonary vein complex in patients with atrial fibrillation. Personal experience and pictorial assay. Radiol Med. 2008;113(6):779–98.PubMed Benini K, Marini M, Del Greco M, Nollo G, Manera V, Centonze M. Role of multidetector computed tomography in the anatomical definition of the left atrium-pulmonary vein complex in patients with atrial fibrillation. Personal experience and pictorial assay. Radiol Med. 2008;113(6):779–98.PubMed
39.
Zurück zum Zitat Toffanin G, Scarabeo V, Verlato R, De Conti F, Zampiero AA, Piovesana P. Transoesophageal echocardiographic evaluation of pulmonary vein anatomy in patients undergoing ostial radiofrequency catheter ablation for atrial fibrillation: a comparison with magnetic resonance angiography. J Cardiovasc Med (hagerstown). 2006;7(10):748–52. Toffanin G, Scarabeo V, Verlato R, De Conti F, Zampiero AA, Piovesana P. Transoesophageal echocardiographic evaluation of pulmonary vein anatomy in patients undergoing ostial radiofrequency catheter ablation for atrial fibrillation: a comparison with magnetic resonance angiography. J Cardiovasc Med (hagerstown). 2006;7(10):748–52.
40.
Zurück zum Zitat Yamashita S, Tokuishi K, Anami K, et al. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg. 2012;42(1):83–8.PubMed Yamashita S, Tokuishi K, Anami K, et al. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg. 2012;42(1):83–8.PubMed
41.
Zurück zum Zitat Yamashita H. Variations in the pulmonary segments and the bronchovascular trees. Roentgenologic anatomy of the lung. Tokyo: Igaku-shoin; 1978. pp. 70–107. Yamashita H. Variations in the pulmonary segments and the bronchovascular trees. Roentgenologic anatomy of the lung. Tokyo: Igaku-shoin; 1978. pp. 70–107.
Metadaten
Titel
Evaluation of pulmonary venous variations in a large cohort
Multidetector computed tomography study with new variations
verfasst von
Derya Altinkaynak, MD
Asli Koktener, MD
Publikationsdatum
12.06.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 19-20/2019
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-019-1517-2

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