Using a customized telescoped stent complex in the percutaneous treatment of a residual superior sinus venosus defect

The management of superior sinus venosus defects (SVD) via transcatheter covered stent (CS) placement is becoming an acceptable alternative to open heart surgery. Though the medium-term success of this procedure has been described, residual shunting from damage to the covering of the implanted stents, use of stents which are too short and unanticipated shortening of stents may result in immediate or short-term procedural failure. In such cases, placement of a second CS may be required to address a residual defect. Preprocedural prediction of the length of stent required for residual leak treatment may not be as accurate as predicting the required stent length in a native defect, meaning that compassionate use applications to facilitate acquiring non-standard stent and balloon combinations may not be practical. We present a successful case of residual SVD closure using a novel sutured telescoping stent technique. Further collaboration with industry should encourage regulatory approval of longer CS, to mitigate the need for potentially unpredictable modifications such as this.