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Use of intravascular stents for superior vena caval obstruction after the Mustard operation
S G MacLellan-Tobert1, F Cetta, D J Hagler
1Section of Pediatric Cardiology, Mayo Clinic Rochester, MN 55905, USA.
Insights
Intravascular stent placement effectively relieves superior vena cava obstruction following the Mustard operation for complete transposition of the great arteries. This minimally invasive procedure offers a safe and successful treatment option for venous pathway complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiac Surgery
Background:
- The Mustard operation, a surgical procedure for complete transposition of the great arteries, can lead to systemic venous pathway obstruction.
- Superior vena cava (SVC) obstruction is a significant complication impacting patient outcomes.
Observation:
- This report details intravascular stent placement in three patients experiencing SVC obstruction post-Mustard operation.
- Four stents were successfully deployed to address baffle obstruction.
Findings:
- Pre-stent mean gradients across the SVC to right atrium were significantly reduced post-procedure (from 10, 8, 6 mm Hg to 3, 0, 1 mm Hg).
- Doppler echocardiography findings correlated well with cardiac catheterization data, confirming gradient reduction.
- No procedural complications were reported.
Implications:
- Intravascular stent placement is an effective treatment for baffle obstruction after the Mustard operation.
- Serial Doppler assessments provide a noninvasive method for monitoring patients post-stent placement.
- This technique improves management of venous pathway complications in complex congenital heart disease.
Abstract:
Obstruction of the systemic venous pathway is a complication in patients who have undergone the Mustard operation for complete transposition of the great arteries. In this report, we discuss intravascular stent placement in three patients for relief of superior vena caval obstruction after the Mustard operation. The clinical history, cardiac catheterization data, and echocardiographic data before and after stent placement are presented for each patient. Overall, four stents were placed. The mean gradients from the superior vena cava to the right atrium before stent placement were 10, 8, and 6 mm Hg, and they decreased to 3, 0, and 1 mm Hg immediately after stent placement. No complications occurred. Doppler echocardiographic assessment of mean gradients before and after stent placement correlated with the mean gradients determined by cardiac catheterization. Intravascular stent placement is effective for relief of baffle obstruction after the Mustard operation. Serial Doppler assessments of the gradient across the stent offer a noninvasive method for follow-up of these patients.