Use of Real-Time 3D Transesophageal Echocardiography in Percutaneous Intervention of a Flush-Occluded Pulmonary Vein

A 52-year-old man presented with progressive dyspnea on exertion and hemoptysis following unsuccessful cardioversion and radiofrequency ablation for paroxysmal atrial fibrillation 5 months earlier. He underwent magnetic resonance angiography and CT angiography to assess pulmonary venous anatomy and to rule out pulmonary embolism. Imaging demonstrated an occluded left-lower pulmonary vein (Figure A).Figure. A, An MRI image showing both arterial and venous phases of filling. A paucity of pulmonary vasculature is seen in the area normally supplied by the left-lower pulmonary vein (white arrow), suggesting occlusion. B, Real-time 3D TEE of the left pulmonary venous system (rotated image) revealing the origin of the occluded left-lower pulmonary vein (top orifice) in relation to the patent left-upper pulmonary vein (bottom orifice). C, Angiographic image revealing wire passage through an …