Unanticipated complication of transcatheter correction of superior sinus venosus atrial septal defect

Abstract

Transcatheter correction of superior sinus venosus atrial septal defect (SVASD) is being considered as an alternative to surgery in selected patients. We present the case of a 42-year-old woman with SVASD and partial anomalous venous connection of the right upper pulmonary vein (RUPV), who underwent transcatheter correction with self-expanding aortic stent graft, following feasibility assessment by balloon occlusion. Hemodynamic parameters and angiography demonstrated successful closure of the SVASD without any residual shunt and unobstructed return of RUPV to the left atrium. She developed cardiac tamponade after a few hours despite pericardial drain and underwent emergency exploratory thoracotomy. This revealed leak from a small rent in the ascending aortic wall adjacent to superior vena cava (SVC) caused by barbs of the stent protruding from SVC, without any leak in SVC. This was repaired with suture and further Teflon was placed around the barbs in SVC to prevent further injury. We also discuss the possible reason for this complication, considering our successful previous two cases with the same stents. This case highlights the importance of assessing the relationship between SVC and aorta to decide about the cranial placement of the aortic stent either by computed tomography prior or by contrast aortogram during the procedure.<Learning objective: Transcatheter correction of superior sinus venosus atrial septal defect is becoming an appropriate alternative option for cardiac surgery. There are multiple reports of this technique in the literature - mostly with balloon expandable stents, and few with self-expanding stents placed in superior vena cava (SVC). We present an unanticipated complication of self-expanding aortic stent in this situation and its management, highlighting the need for assessing the relationship between SVC and aorta to decide about the appropriate placement of stent.>