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Stenting for superior vena cava obstruction in pediatric heart transplant recipients
Ritu Sachdeva1, Paul M Seib, Samuel A Burns
1Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. sachdevaritu@uams.edu
Insights
Superior vena cava (SVC) obstruction is a complication in pediatric heart transplant recipients. Endovascular stents offer a safe and effective treatment for SVC obstruction in these patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Transplant Medicine
Background:
- Superior vena cava (SVC) obstruction is a potential complication following heart transplantation in pediatric patients.
- This study reviews the use of endovascular stents to manage SVC obstruction in this population.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular stent placement for superior vena cava (SVC) obstruction in pediatric heart transplant recipients.
- To identify risk factors and outcomes associated with SVC obstruction after pediatric heart transplantation.
Main Methods:
- Retrospective review of pediatric heart transplant recipients who underwent endovascular stent placement for SVC obstruction.
- Data collected included transplant details, surgical techniques, presenting symptoms, and reintervention rates.
Main Results:
- 5.1% of pediatric heart transplant recipients developed SVC obstruction requiring stent placement.
- SVC obstruction was more common in infants with prior cavopulmonary anastomosis undergoing bicaval anastomosis transplant.
- Three patients required reintervention, and one stent migrated but was retrieved.
Conclusions:
- Superior vena cava (SVC) obstruction is a significant complication in pediatric heart transplant recipients, particularly those with specific surgical histories.
- Endovascular stenting is a safe and effective treatment modality for SVC obstruction in this patient group.
Background:
Superior vena cava (SVC) obstruction can be a complication in heart transplant recipients. We reviewed our experience with relief of SVC obstruction using endovascular stents in pediatric heart transplant recipients.
Methods:
Study cohort included pediatric heart transplant recipients, followed at our institution, who required endovascular stent placement for SVC obstruction. Data retrieved retrospectively included cardiac diagnosis, age, and weight at transplant, surgical technique of transplant (bicaval vs. biatrial anastomosis), previous cardiovascular surgeries, presenting symptoms, date of SVC stent placement, and need for reintervention.
Results:
From March 1990 to June 2006, 5.1% (7/138) pediatric heart transplant recipients who were followed at our institution had SVC obstruction requiring stent placement. Median age and weight at transplant was 9 months and 8.7 kg, respectively. Four patients previously had a cavopulmonary anastomosis. Transplant surgery involved bicaval anastomosis in 6 and biatrial in 1. Of the 7 patients included in the study, 2 were asymptomatic, 2 were symptomatic (1 with chylothorax, 1 with headache), and 3 were identified at the time of transplant surgery. Median time from transplant surgery to SVC stent placement was 2 months (0-14 months). Three patients required reintervention as redilation of SVC stent (n = 1) or additional SVC stent (n = 2). In one patient the stent migrated to the pulmonary artery but was retrieved.
Conclusion:
SVC obstruction can be an important complication following heart transplantation, especially in infants with previous cavopulmonary anastomosis, undergoing heart transplant using bicaval technique. SVC obstruction can be safely and effectively treated using endovascular stents.
