A New Modification of Temporary Suture-Holding Technique for Transcatheter Repair of Sinus Venosus Atrial Septal...

Transcatheter repair of superior sinus venosus atrial septal defect (SVASD) and associated partial anomalous pulmonary venous return (PAPVR) using a covered stent has evolved as a less invasive alternative to surgery. Precise control of stent position remains a key technical challenge during the procedure. Previously, our group has reported on the suture technique with improved outcome. Here, we further report on an enhanced/modified suture technique. We report on a 14-year young boy with a superior SVASD associated with PAPVR of the right middle and upper pulmonary veins who underwent a successful transcatheter repair of the defect using a covered stent with a modification of the previously described novel temporary suture-holding technique by our group. The new modified technique (the holding-wire technique-HWT) uses a 150 cm, 0.018" Terumo® guidewire positioned in the outermost strut of the stent and both ends of the wire are exteriorized from the internal jugular vein to hold the stent temporarily instead of the suture. This allowed precise control and better grip of the attached stent, as well as visualizing the wire on fluoroscopy throughout the procedure. An 80-mm covered stent was deployed and anchored with a 28-mm bare-metal stent proximally, achieving complete exclusion of the atrial communication and rerouted the anomalous vein flow to the left atrium without any obstruction. This simple modification enhances procedural control and safety, and may broaden the clinical applicability of transcatheter SVASD closure.