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Published on: February 8, 2022
International Experience of Transcatheter Sinus Venosus Defect Closure in Children and Adolescents
Puthiyedath Thejaswi1, Pramod Sagar1, Kothandam Sivakumar2
1Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, 4 A Dr JJ Nagar, Mogappair, Chennai, 600089, India.
Insights
Transcatheter closure of sinus venosus defects (SVD) is a safe and effective treatment for children. This minimally invasive approach shows high success rates and minimal complications in pediatric patients.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Transcatheter closure of sinus venosus defects (SVD) is an emerging alternative to surgical repair.
- Concerns exist regarding the growth potential of fixed-diameter stents in pediatric patients.
Purpose of the Study:
- To evaluate the feasibility and safety of transcatheter SVD closure in patients younger than 18 years.
- To assess procedural success, complication rates, and long-term outcomes in this pediatric cohort.
Main Methods:
- Retrospective study of 54 pediatric patients (<18 years) undergoing SVD closure with covered stents.
- Utilized pulmonary vein redirection techniques and jugular-railroad approaches.
- Defined procedural success as complete closure without significant residual flow.
Main Results:
- High procedural success rate (98.1%) with one major complication requiring surgery.
- Low incidence of minor complications, including arrhythmia and stent thrombus.
- Favorable outcomes during follow-up (1-174 months) with no late stent thrombosis and manageable pulmonary vein gradients.
Conclusions:
- Transcatheter SVD closure is feasible and safe in pediatric populations.
- Smaller anatomical structures in children allow for streamlined interventions with smaller sheaths and single stents.
- Long-term surveillance is crucial to confirm sustained benefits in young patients.
Abstract:
Transcatheter closure of sinus venosus defects (SVD) is an emerging alternative to surgery, however, concerns remain regarding growth potential in paediatric patients treated with fixed-diameter stents. This retrospective study included individuals younger than 18 years from 12 centres. SVD closure was performed using covered stents after demonstration of right upper pulmonary vein redirection during balloon interrogation. Complete closure without significant residual flow was defined as procedural success. Major complications were those necessitating surgical intervention, whereas minor complications were managed intraprocedurally. Among 54 patients < 18 years, 17 had bilateral superior vena cava and six had a high-draining vein. The majority (37) underwent single-stent placement; others required multiple stents. Procedural success was 98.1%, with one embolization needing surgery. Seven needed extra stents due to migration or instability. Minor complications included arrhythmia and stent thrombus. Compared to global registry data, this cohort required smaller sheaths and fewer stents. Pulmonary vein protection and jugular-railroad techniques were frequently employed; transseptal puncture was less frequent. Over a follow-up period ranging 1-174 months, three cases of residual shunt necessitated reintervention. No late stent thrombosis was noted. One deep vein thrombosis and two instances of mild asymptomatic pulmonary vein gradients were managed conservatively. Transcatheter closure of SVD is both feasible and safe in paediatric populations. Smaller anatomical structures permitted use of single-stents through smaller sheaths, thereby streamlining the intervention. Continued long-term surveillance will be essential to further elucidate benefits in young patients. Future advancements in stent-technology and increased procedural expertise are expected to enhance outcomes.
