Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Right Upper and Lower Lobe PV Computed tomography images in (A) 2 views of the right superior pulmonary veins (PV) and (B) 2 views of the right inferior PV documenting severe stenosis (arrows). Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Percutaneous Intervention Although the severity and length of stenosis can vary, angiography usually reveals long diffuse disease as seen in this left superior pulmonary vein (LSPV). Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Impact of Stenosis Severity and Affected Vein Number on Symptoms in Pulmonary Vein Stenosis Symptoms emerged at 60% to 70% stenosis, particularly in patients with more than 1 affected vein. Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Impact of Intervention on Doppler Flow Patterns Velocities measured at the time of intervention with improvement following successful treatment. Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Pulmonary Vein Stenosis Positioning and Encroachment (A) Optimal stent position can be obtained with either intracardiac echocardiography or angiography. (B) Intracardiac ultrasound documents suboptimal stent deployment in the LSPV with protrusion into the body of the left atrium. Positioning the stent suboptimally will make cannulation or treatment of the LIPV difficult. LA = left atrium; LIPV = left inferior pulmonary vein; RA = right atrium; RSPV = right superior pulmonary vein; other abbreviations as in Figures 2 and 3. Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Treatment of Left PVS (A) Right anterior oblique (RAO) view of stent in the LSPV. This resulted in compromise of the LIPV. (B) A guidewire is placed through the side of the LSPV stent (RAO) view. (C) A balloon is used to dilate the stent struts and a stent is delivered to the LIPV. (D) The LIPV is dilated. (E) The final angiographic result with wide patency of both superior and inferior pulmonary veins but still residual ostial stenosis. Abbreviations as in Figures 2, 3, and 5. Figure Legend:

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J Am Coll Cardiol Intv. 2009;2(4): doi: /j.jcin Management of PV Stenosis Approach to management of pulmonary vein (PV) stenosis depends on the combination of several factors including patient symptoms, severity of stenosis, and prior treatment. CT/MR = computed tomography/magnetic resonance; PCI = percutaneous coronary intervention; other abbreviations as in Figures 1 and 3. Figure Legend: