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Transesophageal echocardiography (TEE) compares well with multidetector computed tomography (MDCT) for detecting pulmonary vein stenosis and has other advantages, according to researchers.

Transesophageal echocardiography (TEE) compares well with multidetector computed tomography (MDCT) for detecting pulmonary vein stenosis and has other advantages, according to researchers.

In the May issue of the American Heart Journal, Dr. Allan L. Klein and colleagues at the Cleveland Clinic, Ohio note that pulmonary vein isolation is increasingly used to treat atrial fibrillation. However, pulmonary vein stenosis is a potential complication of pulmonary vein isolation, and ideal methods for its detection are still to be determined.

As part of that effort, Dr. Klein and colleagues studied 36 patients who had undergone the procedure and had returned a mean of four months later for follow-up by MDCT and TEE.

MDCT was able to evaluate all four pulmonary veins in each of the subjects (144 veins). However, evaluation by TEE was possible only in 96 per cent of the veins (138 veins).

Using a definition of stenosis as a loss in diameter of 50 per cent or more by MDCT, TEE measurement had a sensitivity of 86 per cent and a specificity of 95 per cent for detection. Clinically significant stenosis was present in two of the subjects and was detected by both TEE and MDCT.

Although good concordance was shown, the researchers note that the methods adopt quite different approaches. MDCT and MRI measure a loss of caliber of the pulmonary ostia compared to an adjacent segment, whereas TEE measures a pressure gradient across the stenosis.

As Dr. Klein pointed out in comments to Reuters Health, "transesophageal echocardiography provides additional data about the functional significance of a pulmonary vein stenosis in patients undergoing pulmonary vein isolation without subjecting patients to unnecessary radiation.