title: Usefulness of vascular stenting with and without transvenous pacing leads for vena caval obstruction among children and adults with repaired congenital heart disease.
abstract: Vena caval obstruction (VCO) is a common complication after vascular manipulation for congenital heart disease. Long-term efficacy of stent therapy for relief of VCO and long-term stent patency with and without intrastent transvenous pacing leads (TPLs) is not well described. This was a retrospective review of patients treated for VCO, including those who received intrastent TPLs, between 1995 and 2012. Patient demographics, diagnoses, vascular pressure gradients, and vessel diameters were analyzed. Forty-one patients (mean age 23.5 ± 10.3 years) with and without congenital heart disease underwent stent implantation, 26 of whom also received intrastent TPLs. Short-term stent implantation success in relieving obstructions was 93%. Poststent vascular pressure gradients and percentage vascular narrowing significantly improved (from 6.2 ± 4.5 to 1.1 ± 1.6 mm Hg and from 63.1 ± 19.5% to 18.0 ± 17.1%, respectively, p <0.05). On follow-up in 38 of 41 patients from 0.2 to 18 years (median 6.0), all survived; 6 (14%) required stent reintervention. Freedom from reintervention was 87% at 15 years. Patients with short-term procedural failure were at higher risk for stent reintervention. Among 27 patients with intrastent TPLs, freedom from reintervention was 96%. In 26 patients with follow-up catheterization, intrastent intimal proliferation was not significantly associated with TPL but was higher in the superior vena cava-innominate vein junction compared with other stent locations (p <0.05). In conclusion, stent therapy for VCO can be successfully and safely performed with good long-term results. Pre-pacing lead stent placement for VCO is effective in allowing TPL placement with encouraging long-term patency.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan. Electronic address: dkobayas@dmc.org.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Forbes
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Turner
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of San Antonio, Christus Santa Rosa Health System, Baylor College of Medicine, San Antonio, Texas.
authors.forename: Harinder R
authors.initials: HR
authors.lastname: Singh
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Karpawich
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of San Antonio, Christus Santa Rosa Health System, Baylor College of Medicine, San Antonio, Texas.
authors.forename: Srinath T
authors.initials: ST
authors.lastname: Gowda
mesh_terms: D000328:Adult; D000792:Angiography; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency