Related Experiment Video
Updated: Jul 19, 2026
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Superior vena cava stenting and transvenous pacemaker implantation (stent and pace) after the Mustard operation
Mathias Emmel1, Narayanswami Sreeram, Konrad Brockmeier
1Klinik und Poliklinik für Kinderkardiologie, Klinikum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Germany.
Insights
Stenting superior vena cava stenosis in patients after Mustard operation enables transvenous pacemaker lead implantation. This approach offers good intermediate-term results for managing bradyarrhythmia and venous pathway obstruction.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Interventional Cardiology
Background:
- The Mustard operation for transposition of the great arteries (TGA) offers good long-term survival.
- Complications include sinus node dysfunction and superior vena cava (SVC) obstruction, hindering transvenous pacing.
Purpose of the Study:
- To evaluate the efficacy of stent implantation for SVC stenosis in patients with Mustard operation.
- To facilitate transvenous permanent pacemaker implantation in this patient cohort.
Main Methods:
- Retrospective review of 7 patients (median age 14.1 years) with Mustard operation, bradyarrhythmia, and SVC stenosis/occlusion.
- SVC stent implantation, followed by transvenous pacemaker implantation (simultaneously or 6 weeks later).
Main Results:
- Stent implantation successfully relieved SVC obstruction in all 7 patients.
- Transvenous pacemaker leads were successfully implanted in all patients.
- Good chronic pacing thresholds and sensing were achieved with uneventful follow-up in most patients.
Conclusions:
- Stenting SVC stenosis is an effective strategy to enable transvenous pacemaker lead implantation in patients post-Mustard operation.
- This intervention provides good intermediate-term outcomes for managing complex pacing needs in TGA survivors.
Abstract:
The Mustard operation for transposition of the great arteries is associated with good long-term survival. Typical complications at follow-up include progressive loss of sinus node function requiring permanent pacemaker implantation, and systemic venous pathway obstruction often precluding a transvenous approach to pacing. We report on 7 patients (median age 14.1; range 5-19) with bradyarrhythmia requiring permanent pacemaker implantation with associated stenosis (n = 6) or occlusion (n = 1) of the superior vena cava, in whom stent implantation relieved the obstruction and facilitated subsequent transvenous permanent pacing. In five of them stenting and pacemaker implantation were performed during a single procedure; two patients underwent elective pacemaker implantation 6 weeks later. In one patient the pacemaker had to be explanted due to pacemaker pocket infection. In the others the follow-up has been uneventful, with excellent chronic pacing thresholds and appropriate sensing. Two patients have had their generator replaced electively.We conclude that stenting of the SVC stenosis allows implantation of transvenous pacemaker leads with good intermediate term results in patients with a Mustard operation for transposition of the great arteries.
More Related Videos
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:29Cardiomyopathy V: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management