Balloon expandable stent implantation for superior vena caval obstruction following surgical repair of partial anomalous pulmonary venous drainage: Medium term follow-up

Abstract

BackgroundObstruction to the superior vena cava (SVC) is a well described complication of surgical repair of right sided partial anomalous pulmonary venous drainage. MethodsReview of the surgical, catheter and cardiology databases at three institutions over 10 year period. ResultsSeven patients were identified with SVC obstruction at a median of 0.6 years (range 0.3–3.3) after surgical repair of right sided anomalous pulmonary venous drainage to the SVC or SVC/right atrial junction. All were symptomatic and had undergone either standard repair or the ‘Warden procedure’. Bare metal stents were implanted percutaneously in all patients via the right femoral vein. Mean pullback pressure gradients fell from a median of 11 mmHg (Range 7–20) to 1 mmHg (Range 0–2 mmHg) and minimum caval diameter increased from a median of 5 mm (Range 2.4–6) to 13 mm (Range 7.6–16). At median follow-up interval of 9.1 years (5.8–10) all remain well although one patient had developed stent fractures necessitating further stent implantation and three patients required further balloon dilation of the stent. All remain in sinus rhythm with no PR interval prolongation. ConclusionStent implantation offers effective medium-term relief of acquired superior vena caval obstruction after surgical repair of right sided anomalous pulmonary venous repair.