Author + information
- Received October 21, 2019
- Revision received December 9, 2019
- Accepted December 30, 2019
- Published online March 16, 2020.
- Jan Hinnerk Hansen, MD, PhDa,b,
- Phuoc Duong, MDa,c,
- Salim G.M. Jivanji, MDa,
- Matthew Jones, MBBSa,
- Saleha Kabir, PhDa,
- Gianfranco Butera, MD, PhDa,c,
- Shakeel A. Qureshi, MDa and
- Eric Rosenthal, MDa,∗ (, )@erosenthal6
- aDepartment of Paediatric and Adult Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- bDepartment of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
- cSchool of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
- ↵∗Address for correspondence:
Prof. Eric Rosenthal, Evelina London Children’s Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Background The superior sinus venosus atrial septal defect (SVASD) is characterized by deficiency of the common wall between the superior vena cava (SVC) and the right upper pulmonary vein (RUPV), which is no longer committed to the left atrium.
Objectives This study sought to evaluate the potential for redirecting the SVC and RUPV flow to the right and left atria, respectively, by implantation of a covered stent in the SVC.
Methods Review of 48 consecutive adult SVASD patients undergoing assessment for correction. Pre-procedural evaluation included cross-sectional imaging and ex vivo simulation using printed or virtual 3-dimensional models.
Results Transcatheter correction was performed in 25 patients, with a further 6 awaiting stent implantation. Only 8 patients were deemed technically unsuitable. The procedure involved balloon test inflation in the anticipated stent landing zone with simultaneous transesophageal echocardiography and pulmonary venography to confirm defect closure and unobstructed pulmonary venous drainage, followed by deployment of a 10-zig covered Cheatham platinum stent. Stents of lengths between 5 and 8 cm were implanted. A second, uncovered stent was used for anchoring in 9 patients. The RUPV was protected with a high-pressure balloon during stent implantation to prevent pulmonary venous obstruction in 4 patients. The median follow-up period was 1.4 (interquartile range: 0.8 to 1.7) years, with no mortality. Stent embolization occurred in 1 patient; another required drainage of hemopericardium. Cardiac computed tomography after 3 months confirmed unobstructed pulmonary venous return. At latest follow-up, a residual shunt was present in 1 patient.
Conclusions Transcatheter correction of SVASD may be considered as an alternative to surgery in a substantial proportion of patients.
Dr. Duong has been funded by/supported by the National Institute for Health Research Cardiovascular MedTech Co-operative. Dr. Qureshi is a consultant for NuMED. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 21, 2019.
- Revision received December 9, 2019.
- Accepted December 30, 2019.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.