Percutaneous transvenous angioplasty of a stenosed bicaval anastomosis after orthotopic cardiac transplantation

Pedrazzini, Giovanni; Mohaçsi, Paul; Meyer, B; Carrel, Thierry; Meier, Bernhard

doi:10.1016/s0022-5223(96)70027-2

Cited by 15 publications

(12 citation statements)

References 5 publications

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“…Superior vena cava (SVC) obstruction has emerged as a notable complication following OHT, particularly with the bicaval method of graft implantation. 1–3 It has been postulated that younger age at transplantation, donor—recipient caval mismatch, 4,5 and previous surgery involving the SVC, 6 and previous superior cavopulmonary anastomosis (CPA) 7 may be risk factors for posttransplant SVC obstruction. However, the incidence of SVC obstruction in pediatric heart transplant patients and the effect of pretransplant exposure to previous superior CPA or other types of non-CPA SVC surgeries remain unknown.…”

mentioning

confidence: 99%

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Aldoss¹,

Arain²,

Vinocur³

et al. 2013

The American Journal of Cardiology

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The risk factors for superior vena cava (SVC) obstruction after pediatric orthotopic heart transplantation (OHT) have not been identified. This study tested the hypothesis that pretransplant superior cavopulmonary anastomosis (CPA) predisposes patients to SVC obstruction. A retrospective review of file Pediatric Cardiac Care Consortium registry from 1982 through 2007 was performed. Previous CPA, other cardiac surgeries, gender, age at transplantation, and weight at transplantation were assessed for the risk of developing SVC obstruction. Death, subsequent OHT, or reoperation involving the SVC were treated as competing risks. Of the 894 pediatric OHT patients identified, 3.1% (n = 28) developed SVC obstruction during median follow-up of 1.0 year (range: 0 to 19.5 years). Among patients who developed SVC obstruction, 32% (n = 9) had pretransplant CPA. SVC surgery before OHT was associated with posttransplant development of SVC obstruction (p <0.001) after adjustment for gender, age, and weight at OHT and year of OHT. Patients with previous CPA had increased risk for SVC obstruction compared with patients with no history of previous cardiac surgery (hazard ratio 10.6,95% confidence interval: 3.5 to 31.7) and to patients with history of non-CPA cardiac surgery (hazard ratio 4.7,95% confidence interval: 1.8 to 12.5). In conclusion, previous CPA is a significant risk factor for the development of post—heart transplant SVC obstruction. Published by Elsevier Inc. (Am J Cardiol 2013;112:286–291)

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confidence: 99%

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Aldoss¹,

Arain²,

Vinocur³

et al. 2013

The American Journal of Cardiology

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“…The published experience with management of SVC stenosis and thrombosis following orthotopic heart transplantation is currently limited to small case series and case reports . Sze et al.…”

Section: Discussionmentioning

confidence: 99%

“…The published experience with management of SVC stenosis and thrombosis following orthotopic heart transplantation is currently limited to small case series and case reports (1,2,7). Sze et al reported the incidence of SVC stenosis following heart or heart-lung transplantation involving the bicaval technique to be 2.4% (3/127) over a five-yr period.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure involves a primary end‐to‐end anastomosis between the vena cavae of the donor and recipient. This places the patient at risk for complications at the anastomotic site, specifically stenosis and thrombosis with the potential for acute superior vena cava (SVC) obstruction . Several treatment modalities for acute SVC obstruction following solid organ transplant have been considered, including thrombolysis (drug and mechanical), angioplasty, and stenting .…”

mentioning

confidence: 99%

“…There is a single report of rheolytic thrombolysis with stent implantation utilized in a 37‐yr‐old patient for acute SVC obstruction 11 days after a heart–lung transplant for cystic fibrosis. This modality was pursued due to multiple complications precluding the utilization of drug thrombolysis, including a recent operation, history of bleeding events, and intracranial lesions . To date, there has not been a similar case of rheolytic therapy utilized in a child with acute SVC obstruction following cardiac transplantation.…”

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confidence: 99%

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AngioJet^™ thrombolysis of SVC thrombosis after orthotopic heart transplantation: A case report

Sessions

Anderson

Johnson

et al. 2016

Pediatric Transplantation

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SVC obstruction is a rare acute complication after bicaval cardiac transplantation and can be catastrophic for the patient. Herein, we report the case of a child who developed SVC thrombosis causing acute SVC syndrome nine days after heart transplantation. Thrombolysis was successfully performed using the AngioJet system and subsequent balloon angioplasty with re-establishment of flow. This procedure allowed for revascularization without repeat sternotomy or stent implantation. The patient is well without recurrence at last follow-up.

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Endovascular stent placement for venous obstruction after cardiac transplantation in children and young adults

Jayakumar

Hsu

Hellenbrand

et al. 2002

Cathet Cardio Intervent

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Survival following cardiac transplantation in children and adults, including the group with complex congenital heart disease, has improved over the last decade secondary to medical and surgical advances in management. There have been rare reports of superior vena cava obstruction at anastomotic sites following transplantation. In patients following heart transplantation, venous stenosis can limit the ability to perform endomyocardial biopsies. We reviewed our experience in three patients who underwent cardiac transplantation and developed significant venous stenosis requiring intervention. All three were successfully treated by transcatheter implantation of endovascular stents. Endovascular stent implantation for venous obstruction in patients following cardiac transplantation was safe and effective, allowing improved ease of catheterization for future posttransplantation monitoring and surveillance.

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Percutaneous transvenous angioplasty of a stenosed bicaval anastomosis after orthotopic cardiac transplantation

Cited by 15 publications

References 5 publications

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

AngioJet^™ thrombolysis of SVC thrombosis after orthotopic heart transplantation: A case report

Endovascular stent placement for venous obstruction after cardiac transplantation in children and young adults

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Percutaneous transvenous angioplasty of a stenosed bicaval anastomosis after orthotopic cardiac transplantation

Cited by 15 publications

References 5 publications

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

AngioJet™ thrombolysis of SVC thrombosis after orthotopic heart transplantation: A case report

Endovascular stent placement for venous obstruction after cardiac transplantation in children and young adults

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Product

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AngioJet^™ thrombolysis of SVC thrombosis after orthotopic heart transplantation: A case report