Recanalisation of bilateral superior vena cava after total cavopulmonary connection. Interventional occlusion with the Amplatzer VSD Occluder.
Formation of systemic to pulmonary venous or systemic venous left atrial collaterals frequently occurs in patients after Glenn or Fontan-type operations. Embolization with detachable metal coils is the therapy of choice for the closure of small vessels. These devices however are not appropriate for the occlusion of large collaterals, e. g. recanalized bilateral caval veins. We report two patients who presented late after Fontan-type operations with a gradual decrease in oxygen saturation due to recanalisation of bilateral caval veins. Interventional closure of these large veins was carried out successfully with the use of 8 mm Amplatzer muscular VSD Occluders, resulting in an increase of arterial oxygen saturations.


CONCLUSIONS
The closure of recanalized bilateral superior caval veins after Fontan procedures is possible without technical problems by means of the Amplatzer muscular VSD Occluder. In order to avoid future formation of venous collaterals via the azygos or hemiazgos system, the occluder should be placed in the vena cava below the orifice of the azygos/ hemiazygos vein.
University Hospital for Children and Adolescents, Department of Pediatric Cardiology, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. monika.girisch@med.uni-tuebingen.de
M
M
Girisch
L
L
Sieverding
R
R
Rauch
R
R
Kaulitz
M
M
Gass
G
G
Ziemer
M
M
Hofbeck
D000328:Adult; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D018729:Fontan Procedure / Q000009:adverse effects*; D018610:Heart Bypass, Right / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy*; D012086:Reoperation; D016896:Treatment Outcome