Haemoptysis as a late complication of a Mustard operation treated by balloon dilation of a superior caval venous obstruction

Haemoptysis was the presenting symptom in a 27-year-old male. He had undergone a Mustard operation for connection of complete transposition at the age of 2 years. For 6 months prior to admission, he had complained of dyspnoea without chestpain, and swelling of the fingers during hard physical work. Chest radiography and computer tomographic scans showed normal features of the pulmonary parenchyma, and no sign of cardiomegaly or vascular stasis. Fiberoptic bronchoscopy demonstrated a blood clot in the upper right bronchus, without any associated abnormalities of the bronchial tree. Doppler echocardiography showed obstruction of the superior caval vein, which was verified by cardiac catheterization. Balloon dilation at the site of obstruction increased the diameter of the vein from 0.5 to 1.7 cm, and the mean pressure in the superior caval vein was reduced significantly from 18 to 10 mmHg. The haemoptysis did not recur, and no complaints of dyspnoea or swelling of fingers during physical activity was reported 2 years later. Transthoracic echocardiography undertaken at this time revealed no obstruction of the superior caval vein. We conclude that hemoptysis is a rare complication of increased venous pressure in the upper body of patients with superior caval venous obstruction, which can be treated by balloon dilation or stenting.

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Successful dilation of superior cavel venous obstruction following repair of totally anomalous pulmonary venous connection

Cardiology in the Young ◽

10.1017/s1047951100005928 ◽

1997 ◽

Vol 7 (1) ◽

pp. 88-90

Author(s):

S. Shrivastava ◽

S. Radhakrishnan ◽

Y. Vijaya Chandra

Keyword(s):

Balloon Dilation ◽

Venous Obstruction ◽

Caval Vein ◽

Superior Caval Vein ◽

Anomalous Pulmonary Venous Connection

AbstractWe describe post azygos obstruction of the superior caval vein following repair of a mixed variety of totally anomalous pulmonary venous connection. Balloon dilation was immediately successful, and has provided persistent relief at a follow-up of 20 months.

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Placement of endovascular stents for systemic venous obstruction after the Mustard operation

Cardiology in the Young ◽

10.1017/s1047951100002390 ◽

1994 ◽

Vol 4 (4) ◽

pp. 390-394 ◽

Cited By ~ 1

Author(s):

Jassim M. Abdulhamed ◽

Saad Al Yousef ◽

Mohamed A. Ali Khan ◽

Martin O'Laughlin

Keyword(s):

Balloon Catheter ◽

Balloon Dilation ◽

The Other ◽

Complete Relief ◽

Venous Obstruction ◽

Endovascular Stents ◽

The Third ◽

Mustard Operation ◽

First Case ◽

Stenotic Area

AbstractThree patients aged five years, five years four months and 14 years with obstruction of the systemic venous baffle following the Mustard operation were treated with balloon dilation and implantation ofstents. Balloon dilation of the baffle obstruction was performed initially in the first two cases. In the third case, the obstruction was complete and was punctured with atranseptal needle via a 6 French transeptal sheath followed by a balloon dilation. in all three patients, a Palmaz stent (Johnson & Johnson, Summerville, New Jersey, USA) was loaded onto the balloon catheter and delivered into the stenotic area. There was complete relief of obstruction in allcases. The first case developed supraventricular tachycardia at the time ofcatheterization, the morning following implantation of the stent and thentwo weeks after that. There were no complications with catheterization and noshort-term side effects in the other cases. These cases illustrate the use of endovascular stents in the treatment of baffle obstruction.

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Alterations in mean peripheral-central venous pressure gradient and flow in the superior caval vein of healthy individuals and patients with mitral valve disease during submaximal leg exercise

Basic Research in Cardiology ◽

10.1007/bf01906418 ◽

1973 ◽

Vol 68 (2) ◽

pp. 97-107 ◽

Cited By ~ 1

Author(s):

M. Schlepper

Keyword(s):

Mitral Valve ◽

Pressure Gradient ◽

Central Venous Pressure ◽

Mitral Valve Disease ◽

Venous Pressure ◽

Healthy Individuals ◽

Central Venous ◽

Caval Vein ◽

Superior Caval Vein ◽

Leg Exercise

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The bronchial cast syndrome after the Fontan procedure: further evidence of its etiology

Cardiology in the Young ◽

10.1017/s1047951101000385 ◽

2001 ◽

Vol 11 (3) ◽

pp. 345-351 ◽

Cited By ~ 13

Author(s):

Colin J. McMahon ◽

Michael R. Nihill ◽

Adele Reber

Keyword(s):

Central Venous Pressure ◽

Venous Pressure ◽

Pulmonary Atresia ◽

Fontan Circulation ◽

Central Venous ◽

Caval Vein ◽

Superior Caval Vein ◽

Hemodynamic Assessment ◽

The Right ◽

Bronchial Casts

We describe a three-year-old boy who presented with recurrent expectoration of bronchial casts six months following creation of a fenestrated lateral tunnel Fontan circulation for pulmonary atresia with intact ventricular septum. Cardiac catheterization demonstrated elevated central venous pressure with two areas of stenosis within the Fontan circuit, specifically at the junction of the right superior caval vein and the right pulmonary artery, and between the atrial baffle and the right superior caval vein. Insertion of Palmaz stents in these areas resulted in a reduction in central venous pressure, and a transient reduction in production of casts. Eight weeks after catheterization, however, he produced further casts, which resulted in hypoxia, respiratory arrest and death. We reviewed the autopsied specimens obtained from patients with the Fontan circulation over an eleven-year period at our institution in order to ascertain the prevalence of subclinical production of bronchial casts. We found no casts in the thirteen patients examined. Hemodynamic assessment is vital in all patients who develop this syndrome, and should be the primary focus of investigation, rather than solely directing efforts at lysis of casts.

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Divided left atrium associated with supravalvar mitral ring

Cardiology in the Young ◽

10.1017/s1047951100005242 ◽

1999 ◽

Vol 9 (4) ◽

pp. 423-426 ◽

Cited By ~ 7

Author(s):

Silvia Álvares ◽

António Sá Melo ◽

Manuel Antunes

Keyword(s):

Pulmonary Hypertension ◽

Left Atrium ◽

Septal Defect ◽

Pulmonary Venous Obstruction ◽

Venous Obstruction ◽

Caval Vein ◽

Interatrial Communication ◽

Superior Caval Vein ◽

Rare Association ◽

Echocardiographic Examination

AbstractReported is a case with a rare association of divided left atrium, supramitral stenosing ring of the left atrium, connection of the left superior caval vein to the roof of the left atrium, unroofed coronary sinus with an interatrial communication at the mouth of the unroofed sinus and ventricular septal defect. The need for a complete echocardiographic examination in the presence of pulmonary venous obstruction is emphasized. Surgery was successful in spite of significant preoperative pulmonary hypertension.

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Recanalisation of the left superior caval vein after Fontan procedure: not so rare complication: possibilities of percutaneous closure using various devices

Cardiology in the Young ◽

10.1017/s104795111400016x ◽

2014 ◽

Vol 25 (3) ◽

pp. 485-490

Author(s):

Jacek Kusa ◽

Leslaw Szydlowski ◽

Ewa Nowakowska ◽

Agnieszka Skierska

Keyword(s):

Rare Complication ◽

Fontan Procedure ◽

Arterial Oxygen Saturation ◽

Percutaneous Closure ◽

Arterial Oxygen ◽

Total Cavopulmonary Connection ◽

Sudden Increase ◽

Caval Vein ◽

Superior Caval Vein ◽

Cavopulmonary Connection

AbstractAim: Evaluation of possibilities of percutaneous closure of recanalised left superior caval vein after total cavopulmonary connection.Methods and Results: We analysed 19 patients after total cavopulmonary connection catheterised because of a sudden increase of desaturation. In four of them, the recanalisation of the left superior caval vein was identified. For this reason, the balloon occlusion tests of the veins were made temporarily. In all cases, the haemodynamic status of patients did not change, and arterial oxygen saturation increased significantly. Thus, using different types of implants, these veins were closed effectively in all patients. During the short-term follow-up, the effectiveness of treatments and constantly maintaining a high level of saturation were confirmed.Conclusions: Meticulous investigation of unclear causes of desaturation in cyanotic patients after Fontan completion is necessary. Almost all causes of desaturation, including recanalised additional left superior caval vein, can be effectively treated percutaneously.

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Venous obstruction due to insertion of permanent transvenous pacemaker electrodes in children

Cardiology in the Young ◽

10.1017/s1047951100004364 ◽

1997 ◽

Vol 7 (4) ◽

pp. 375-377 ◽

Cited By ~ 2

Author(s):

Alpay Çeliker ◽

Kürsad Tokel ◽

Ferhun Balkanci ◽

Saruhan Çekirge ◽

Ali Oto ◽

...

Keyword(s):

Subclavian Vein ◽

Collateral Circulation ◽

Digital Subtraction ◽

Venous Obstruction ◽

Caval Vein ◽

Complete Occlusion ◽

Significant Stenosis ◽

Superior Caval Vein ◽

Pacemaker Leads ◽

Pacemaker Electrodes

AbstractTransvenous placement of pacemaker leads is the recommended method for permanent pacemaking in children. We evaluated 11 children with transvenous ventricular pacemaker leads by digital subtraction angiography in order to determine the incidence of venous obstruction. The ages at the implantation ranged from 4.5 to 11.2 years with a mean of 8.05±2.17 and a median of 7.9 years. The interval from implantation to the time of procedure ranged from 12 to 64 months, with a mean of 37.4±19.2 and a median of 45 months. Complete occlusion of the subclavian vein was demonstrated in two patients. We also showed significant stenosis of the venous system in five further patients. Of the 7 patients, 5 had an extensive venous collateral circulation. We did not observe obstruction of the superior caval vein, or superior caval venous syndrome. Although we did not demonstrate this syndrome, we propose future regular evaluation of all our children undergoing transvenous pacemaking. This point may be important when second or third leads are implanted.

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Slow pathway cryoablation in a child with absent right superior caval vein and persistent left superior caval vein draining into the coronary sinus

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.10.141 ◽

2015 ◽

Vol 178 ◽

pp. 178-180

Author(s):

Alfredo Di Pino ◽

Elio Caruso ◽

Placido Gitto ◽

Luca Costanzo ◽

Salvatore Patanè ◽

...

Keyword(s):

Coronary Sinus ◽

Slow Pathway ◽

Caval Vein ◽

Superior Caval Vein

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Long-term outcome after percutaneous closure of persistent left superior caval vein draining into the left atrium: a contrast-enhanced CT study

Cardiology in the Young ◽

10.1017/s1047951117000737 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1550-1556 ◽

Cited By ~ 1

Author(s):

Davide Marini ◽

Matteo Castagno ◽

Michele Millesimo ◽

Francesca Ferroni ◽

Gaetana Ferraro ◽

...

Keyword(s):

Left Atrium ◽

Percutaneous Closure ◽

Caval Vein ◽

Term Outcome ◽

Long Term Outcome ◽

Superior Caval Vein ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

AbstractBackgroundData regarding long-term outcome after percutaneous closure of left superior caval vein draining into the left atrium are lacking. The aim of the present study was to report the long-term follow-up by using contrast-enhanced CT.MethodsIn all, three patients underwent percutaneous closure of left superior caval vein draining into the left atrium between 2005 and 2015. All of them were evaluated clinically and underwent contrast-enhanced CT.ResultsIn one patient, the Amplatzer® Septal Occluder was used. In two patients, the Amplatzer® Vascular Plug type-1 was preferred: the device size/LSVC diameter ratio was 1.7 in the child and 1.2 in the adult. There were no early-onset or long-term onset complications. CT was performed 1, 2, and 10 years after the procedure, respectively. Complete occlusion of the vessel was documented in all. After 10 years since the procedure, CT revealed a persistent trivial residual shunt through the accessory hemiazygos vein in one patient, in whom the device was implanted above its drainage into the left superior caval vein. When an Amplatzer® Vascular Plug type-1 is oversized compared with the venous vessel diameter, it immediately assumes a dog-bone shape that disappears early to regain its shape memory and nominal size.ConclusionsPercutaneous occlusion of left superior caval vein draining into the left atrium has excellent early and long-term outcomes. The optimal implantation of the device is below the drainage of the accessory hemiazygos vein, when present. The device might be oversized compared with the left superior caval vein diameter according to the age of the patient.

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