Case Report: Intracardiac echocardiography-guided pulmonary vein stenting for pulmonary vein stenosis caused by a left atrial tumor.

BACKGROUND: Pulmonary vein stenosis (PVS) caused by a cardiac tumor is rare, and experience with transcatheter pulmonary vein stenting is limited. We report a challenging case of symptomatic PVS managed with intracardiac echocardiography (ICE)-guided pulmonary vein stenting as palliative treatment. CASE: An 83-year-old woman presented with progressive dyspnea for 4 months. Electrocardiography, chest x-ray, and routine laboratory tests were unremarkable. Transthoracic echocardiography revealed a large left atrial mass involving the right pulmonary vein and causing stenosis. Multimodality imaging, including cardiac computed tomography (CT), cardiac magnetic resonance imaging, and 1⁸F-FDG PET/CT, suggested primary cardiac angiosarcoma. Considering the patient's advanced age and poor surgical candidacy, we selected a palliative transcatheter intervention. Under ICE guidance, transseptal puncture was performed. Pulmonary venography revealed severe stenosis of the right inferior pulmonary vein. After sequential balloon angioplasty, a 14 × 40 mm self-expanding stent was successfully implanted with adjunctive balloon dilation. Final angiography demonstrated complete restoration of pulmonary venous flow without residual stenosis or procedural complications. The patient's dyspnea improved markedly, and she was discharged 2 days after the procedure. CONCLUSION: In selected patients with PVS who are unsuitable for surgical treatment, ICE-guided pulmonary vein stenting can be performed safely and may provide effective palliation by restoring pulmonary venous flow and relieving symptoms.