Stenting of the vertical vein in obstructed total anomalous pulmonary venous return as rescue procedure in a neonate

Abstract

A newborn girl with progressive respiratory distress and cyanosis was found to have severely obstructed supracardiac total pulmonary venous return (TAPVR). Stenting of the stenosis provided immediate and effective relief of the obstruction until corrective surgery was performed. Catheter intervention should be considered in high-risk infants with obstructed supracardiac TAPVR as part of the strategy for preoperative cardiovascular stabilization.

Elective Stent Implant in the Obstructed Vertical Vein of Supracardiac Total Anomalous Pulmonary Venous Connection Prior to Operative Repair

“…Over the last decade, surgical outcomes of TAPVC repair have improved with better control of pulmonary hypertension and preoperative clinical stabilization due to more aggressive medical management [6,9]. Our case presents an opportunity to consider an interventional strategy that palliates the disease to prevent an urgent need for definitive repair.…”

“…Low birth weight is an independent risk factor in the operative management of obstructive TAPVC [5,6,9]. Patients who undergo emergent VV stent implantation prior to definitive surgery often present with respiratory distress and cyanosis secondary to pulmonary congestion [4].…”

“…It is traditionally considered a surgical emergency. Emergent stenting of the VV is rarely reported but has been performed when a patient is considered a poor candidate for surgical repair [4][5][6]. Pulmonary venous obstruction is associated with poor prognosis and a high risk of operative mortality [7,8].…”

Life-saving urgent intervention in a low-birth-weight newborn with obstructed supracardiac total anomalous pulmonary venous connection: Stenting the vertical vein

“…Neonates and infants with obstructed TAPVC can present with severe cyanosis, pulmonary hypertension, and low cardiac output, requiring emergency surgical intervention (2). The most common site of obstruction is the vertical vein at the level of the left pulmonary artery and the left main bronchus in patients with supracardiac TAPVC (1, 3).…”

Stenting of the obstructed ductus venosus as emergency and bridging strategy in a very low birth weight infant with infradiaphragmatic total anomalous pulmonary venous connection

“…Unfortunately, not all patients are amenable to surgical correction right away, owing to poor clinical condition or to very small size. In cases of supracardiac TAPVC, palliation by stenting of an obstructed vertical vein has been described , as well as ductus venosus stenting via a transumbilical approach for cases of infracardiac obstruction . A transfemoral approach has been used in one published case of a 2.4 kg neonate .…”