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Superior caval venous syndrome after atrial switch procedure: relief of complete venous obstruction by gradual angioplasty and placement of stents

Published online by Cambridge University Press:  19 August 2008

Ina Michel-Behnke ,
Karl-Jürgen Hagel ,
Jürgen Bauer  and
Dietmar Schranz
Ina Michel-Behnke*
Affiliation:
Department of Paediatric Cardiology, Justus-Liebig University, Gießlen, Germany
Karl-Jürgen Hagel
Affiliation:
Department of Paediatric Cardiology, Justus-Liebig University, Gießlen, Germany
Jürgen Bauer
Affiliation:
Department of Paediatric Cardiology, Justus-Liebig University, Gießlen, Germany
Dietmar Schranz
Affiliation:
Department of Paediatric Cardiology, Justus-Liebig University, Gießlen, Germany
*
Dr.Ina Michel-Behnke, Department of Paediatric Cardiology, Justus-Liebig University, Feulgenstraße 12, 35385 Gießen, Germany. Tel: 049-641-99 43460; Fax: 049-641-99 43469
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Abstract

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Superior caval venous syndrome is one of the late problems known to occur after Mustard repair of complete transposition. Reoperation may leave residual stenosis, and carries substantial risk for the patient. It is now feasible to use intravascular stents to overcome systemic venous baffle obstructions, and such an approach is probably more effective. The purpose of our study therefore, was to assess immediate and medium term results of inserting stents subsequent to gradual balloon enlargement of acquired atresia of the intraatrial baffle in patients who had undergone an atrial switch operation. We investigated five patients with complete obstruction of the superior caval venous pathway at perforation of the atretic segment was achieved using a guide wire technique. The procedure was successful in all patients. Gradual angioplasty was performed and intravascular stents were implanted. The pressure in the superior caval vein dropped to normal values, symptoms improved, and the patency of the newly created venoatrial communication was proven at mid-term follow-up. Thus critical obstructions at the superior caval venous pathway after the Mustard procedure can be reopened by interventional catheterization. Implantation of balloon-expandable intravascular stents is safe and effective in the acute relief of the obstructions, but careful long-term follow-up is mandatory.

Keywords

Mustard procedurebaffle obstructionballoon angioplastystents
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 4 , October 1998 , pp. 443 - 448
Copyright
Copyright © Cambridge University Press 1998

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