SpringerLink
Log in

Recanalisation of bilateral superior vena cava after total cavopulmonary connection

Interventional occlusion with the Amplatzer VSD Occluder

Rekanalisierung bilateraler oberer Hohlvenen nach totaler cavopulmonaler Konnektion—Interventioneller Verschluß mittels Amplatzer VSD Okkluder

  • CASE REPORT
  • Published:
Zeitschrift für Kardiologie Aims and scope Submit manuscript

Zusammenfassung

Systemvenöse Kollateralgefäße werden häufig nach Glenn- oder modifizierter Fontan-Operation beobachtet. Therapie der Wahl zum Verschluss kleinkalibriger Gefäße ist die Embolisation mit Hilfe von replatzierbaren Metallspiralen. Etwas problematischer ist die Situation bei Patienten mit großen Kollateralen wie z. B. einer rekanalisierten bilateralen oberen Hohlvene. Wir berichten über zwei Patienten, bei denen mehrere Jahre nach Fontan-Operation bei zunehmender Zyanose eine rekanalisierte linke bzw. rechte obere Hohlvene diagnostiziert wurde. Bei beiden Patienten gelang der interventionelle Verschluss dieser großlumigen Venen mittels 8 mm Amplatzer®-Muscular-VSD-Occluder, die arteriellen Sauerstoffsättigungen stiegen bei beiden Patienten postinterventionell an.

Schlussfolgerung

Der Verschluss rekanalisierter oberer Hohlvenen nach Fontan’scher Kreislauftrennung ist mittels Amplatzer®-Muscular-VSD-Occluder technisch ohne Probleme möglich. Um die erneute Formation von venovenösen Kollateralen zu vermeiden muss darauf geachtet werden, dass der Okkluder in die V. cava knapp unterhalb der Mündung der V. azygos/hemiazygos platziert wird.

Summary

Formation of systemic to pulmonary venous or systemic venous left atrial collaterals frequently occurs in patients after Glenn or Fontan-type operations. Embolization with detachable metal coils is the therapy of choice for the closure of small vessels. These devices however are not appropriate for the occlusion of large collaterals, e. g. recanalised bilateral caval veins. We report two patients who presented late after Fontan-type operations with a gradual decrease in oxygen saturation due to recanalisation of bilateral caval veins. Interventional closure of these large veins was carried out successfully with the use of 8 mm Amplatzer® muscular VSD Occluders, resulting in an increase of arterial oxygen saturations.

Conclusion

The closure of recanalised bilateral superior caval veins after Fontan procedures is possible without technical problems by means of the Amplatzer® muscular VSD Occluder. In order to avoid future formation of venous collaterals via the azygos or hemiazgos system, the occluder should be placed in the vena cava below the orifice of the azygos/ hemiazygos vein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Bridges ND, Mayer JE, Lock JE, Jonas RA, Hanley FL, Keane JF, Perry SB, Castaneda AR (1992) Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 86:1762–1769

    CAS  PubMed  Google Scholar 

  2. Buheitel G, Hofbeck M, Tenbrink U, Leipold G, v.d. Emde J, Singer H (1998) Possible sources of right- to-left shunting in patients following a total cavopulmonary connection. Cardiol Young 8:358–363

    CAS  PubMed  Google Scholar 

  3. Buirski G, Jordan SC, Joffe HS, Wilde P (1986) Superior vena caval abnormalities: their occurrence rate, associated cardiac abnormalities and angiographic classification in a paediatric population with congenital heart disease. Clinical Radiology 37:131–138

    CAS  PubMed  Google Scholar 

  4. Ewert P, Kretschmar O, Peters B, Abdul Khaliq H, Nagdyman N, Schulze-Neick I, Bass J, Le TP, Lange PE (2004) Transcatheter closure of congenital ventricular septal defects. Z Kardiol 93(2):147–155

    CAS  PubMed  Google Scholar 

  5. Filippini LH, Ovaert C, Nykanen DG, Freedom RM (1998) Reopening of persistent left superior caval vein after bidirectional cavopulmonary connections. Heart 79(5):509–512

    CAS  PubMed  Google Scholar 

  6. Gatzoulis MA, Shinebourne EA, Redington AN, Rigby ML, Ho SY, Shore DF (1995) Increasing cyanosis early after cavopulmonary connection caused by abnormal systemic venous channels. Br Heart J 73(2):182–186

    CAS  PubMed  Google Scholar 

  7. Hayes AM, Burrows PE, Benson LN (1994) A unusual cause of cyanosis after the modified Fontan procedure-closure of venous communications between the coronary sinus and left atrium by transcatheter techniques. Cardiol Young 4:172–174

    Google Scholar 

  8. Heng JT, De Giovanni JV (1997) Occlusion of persistent left superior vena cava to unroofed coronary sinus using vena cava filter and coils. Heart 77(6):579–580

    CAS  PubMed  Google Scholar 

  9. Lock JE, Cockerham JT, Keane JF, Finley JP, Wakely PE Jr, Fellows KE (1987) Transcatheter umbrella closure of congenital heart defects. Circulation 75(3):593–599

    CAS  PubMed  Google Scholar 

  10. Magee AG, McCrindle BW, Mawson J, Benson LN, Williams WG, Freedom RM (1998) Systemic venous collateral development after the bidirectional cavopulmonary anastomosis. Prevalence and predictors. J Am Coll Cardiol 32(2):502–508

    CAS  PubMed  Google Scholar 

  11. McElhinney DB, Reddy VM, Hanley FL, Moore P (1997) Systemic venous collateral channels causing desaturation after bidirectional cavopulmonary anastomosis: evaluation and management. J Am Coll Cardiol 30(3):817–824

    CAS  PubMed  Google Scholar 

  12. Michel-Behnke I, Akinturk H, Schranz D (1999) Reopening of a persistent left superior vena cava in the early postoperative period following bidirectional cavopulmonary anastomosis—treatment by coil embolization. Z Kardiol 88(8):555–558

    CAS  PubMed  Google Scholar 

  13. Peuster M, Beerbaum P (2004) A novel implantation technique for closure of an atypical fenestration connecting the right atrial appendage to an extracardiac conduit by use of a 15 mm Helex device in a patient with total cavopulmonary connection. Z Kardiol 93(10):818–823

    CAS  PubMed  Google Scholar 

  14. Peuster M, Reckers J, Fink C (2002) Interventional therapy of large venovenous collaterals after univentricular palliation for congenital heart disease using the Starflex- and Amplatzer-PDA occluder. Z Kardiol 91(10):853–857

    PubMed  Google Scholar 

  15. Stuemper O, Wright JGC, Sadiq M, De Giovanni JV (1995) Late systemic desaturation after total cavopulmonary shunt operations. Br Heart J 74:282–286

    PubMed  Google Scholar 

  16. Trivedi KR, Freedom RM, Yoo SJ, McCrindle BW, Benson LN (2002) Physiological impact and transcatheter treatment of the persisting left superior caval vein. Cardiol Young 12(3):218–223

    PubMed  Google Scholar 

  17. Weber HS (2001) Incidence and predictors for the development of significant supradiaphragmatic decompressing venous collateral channels following creation of Fontan physiology. Cardiol Young 11(3):289–294

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Hospital for Children and Adolescents, Department of Pediatric Cardiology, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    M. Girisch, L. Sieverding, R. Rauch, R. Kaulitz, M. Gass & M. Hofbeck

  2. Department of Cardiovascular Surgery, University, Tübingen

    G. Ziemer

Authors
  1. M. Girisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Sieverding
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Rauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Kaulitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Gass
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Ziemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Hofbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Girisch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Girisch, M., Sieverding, L., Rauch, R. et al. Recanalisation of bilateral superior vena cava after total cavopulmonary connection. ZS Kardiologie 94, 469–473 (2005). https://doi.org/10.1007/s00392-005-0250-1

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-005-0250-1

Schlüsselwörter

Key words

Search

Navigation