Transcatheter closure of sinus venosus atrial septal defect with anomalous pulmonary venous drainage: Innovative technique with long‐term follow‐up

Abstract

Introduction Surgical closure of sinus venosus atrial septal defect (SVASD) is the standard management. A safe and effective transcatheter approach will be an attractive option. Objectives To assess the feasibility and long‐term safety of transcatheter closure of SVASD with anomalous pulmonary venous drainage. Patients and methods From July 2011 to October 2013, four patients with large SVASD and anomalous right upper pulmonary venous (RUPV) drainage underwent transcatheter closure of their defects at Ibn‐Albitar Center for Cardiac Surgery, Baghdad, Iraq. Two patients with superior vena cava (SVC)‐type SVASD underwent closure using covered Cheatham‐Platinum (CP) stents with no need for septal occluder. The other two patients had large RA‐type SVASD who underwent closure using covered CP stents only in one patient and stents and device in the other one. An angiogram in the RUPV during balloon inflation in the SVC was done to ensure that the RUPV drains back to the left atrium. The covered CP stent was mounted and hand crimped onto Z‐Med™ or BIB‐balloon catheters and deployed in the desired location under transesophageal echocardiography guidance. Results The two patients with SVC‐type SVASD underwent successful closure using two overlapping covered CP stents implanted in the SVC, thus creating total septation between the SVC and the RUPV. The RA‐type SVASD patients underwent closure using two overlapping covered CP stents. One with mild to moderate residual shunt that completely disappeared at 12 months follow‐up after implantation of a second 45 mm CP stent. A significant residual shunt in the second patient was closed successfully using a PFO device. Conclusion Transcatheter closure of SVASD through SVC stent insertion with or without subsequent device implantation is feasible and effective.

Device Closure of a Sinus Venosus Atrial Septal Defect

“…These factors help predict closure of the defect, stent stability, and the risk of PV, innominate vein, or azygous vein obstruction. 1,3,4 TEE imaging for SVASD device closure is significantly different than for secundum ASD closure (see Figure 1C, D). Compared to the deployment of a covered stent as described above, a secundum ASD device has 2 connected discs that sit on either side of the atrial septum sealing the defect.…”

Rapid Prototyping and Image Fusion Guidance for Transcatheter Closure of Superior Sinus Venosus Atrial Septal Defect

“…Although a case series of four patients with follow-up period ranging from 4 to 6 years describes safe and feasible transcatheter SVASD closure [5], future studies in a larger cohort of patients are required to evaluate the long-term outcomes of surgical vs. transcatheter closure of SVASD, including those with evidence of PH with preserved pulmonary vascular vasoreactivity.…”

New Insights into Sinus Venosus Defects from Cross-Sectional Imaging

“…Since its introduction in 2013 by Abdullah et al and in 2014 by Garg et al, transcatheter approach using a covered stent has increasingly been adapted [53,[70][71][72]. A large clinical series showed a suitability of transcatheter correction in >75% of patients with superior sinus venosus defect [53].…”