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Stent implantation for post-Mustard systemic venous obstruction
G Santoro1, L Ballerini, J Bialkowski
1Pediatric Cardiology, Ospedale Bambino Gesù, Rome, Italy.
Insights
Stent implantation effectively treats late-onset systemic venous obstruction after the Mustard procedure. This minimally invasive approach improved vessel diameter and relieved pressure gradients, with no recurrence observed during follow-up.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Late-onset systemic venous obstruction is a potential complication following the Mustard procedure for congenital heart disease.
- Obstructive caval syndrome can significantly impact patient quality of life and requires effective treatment strategies.
Observation:
- Three patients with symptomatic late-onset post-Mustard systemic venous obstruction were treated.
- Initial balloon dilation was unsuccessful in relieving the obstruction.
Findings:
- Palmaz-Schatz stents were successfully implanted at the veno-atrial junction, followed by high-pressure balloon dilation.
- Significant improvements were observed: vessel diameter increased from 4.4+/-1.8 mm to 13+/-1.7 mm (P < 0.05), and the trans-stenotic pressure gradient decreased from 8+/-6 mmHg to 0 mmHg (P < 0.01).
- All patients showed clinical improvement post-intervention.
Implications:
- Stent implantation offers a safe and effective therapeutic option for managing late-onset systemic venous obstruction after the Mustard operation.
- This technique provides durable relief from obstructive caval syndrome, as evidenced by the absence of recurrent stenosis at a mean follow-up of 26+/-4 months.
- The findings support the use of endovascular stenting as a primary or salvage therapy in this patient population.
Abstract:
In this paper, we report on the use of stents in the treatment of late-onset post-Mustard systemic venous obstruction in three patients with clinical signs of obstructive caval syndrome. After unsuccessful balloon dilation, Palmaz-Schatz stents were implanted at the veno-atrial junction. Further dilation has been achieved using high-pressure balloons. Vessel diameter increased from 4.4+/-1.8 to 13+/-1.7 mm (P < 0.05) and the trans-stenotic pressure gradient dropped from 8+/-6 to 0 mmHg (P < 0.01), with clinical improvement. After 26+/-4 months of non-invasive follow-up, no signs of recurrent stenosis were observed. Stent implantation is effective in the treatment of systemic venous obstruction after Mustard operation.