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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Endovascular Treatment for Superior Vena Cava Occlusion or Obstruction in a Pediatric and Young Adult Population

A 22-Year Experience

Aphrodite Tzifa, MD, MRCPCH^_*,, Audrey C. Marshall, MD^_*, Doff B. McElhinney, MD^_*, James E. Lock, MD, FACC^_* and Robert L. Geggel, MD, FACC^_*,_*

^_* Department of Cardiology, Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Department of Congenital Heart Disease, Evelina Children’s Hospital, Guy’s & St. Thomas’ NHS Trust, London, United Kingdom.

Manuscript received August 3, 2006; revised manuscript received September 29, 2006, accepted October 23, 2006.

^_* Reprint requests and correspondence: Dr. Robert L. Geggel, Children’s Hospital, Department of Cardiology, 300 Longwood Avenue, Boston, Massachusetts 02115. (Email: robert.geggel{at}cardio.chboston.org).

Objectives: The purpose of this research was to investigate the causes and symptoms of superior vena cava (SVC) obstruction or occlusion and report on the long-term results of transcatheter therapy.

Background: Information on transcatheter therapy for SVC obstruction is limited.

Methods: Superior vena cava catheterization interventions between August 1984 and April 2006 were reviewed. Patients were divided into 2 subgroups depending on whether or not they had previously undergone congenital cardiac surgery.

Results: Sixty-three patients with median age of 3.7 years (range 1 month to 42 years) and weight of 13.3 kg (range 3 to 114 kg) were treated. Fifty patients (79%) were symptomatic, although only 50% had symptoms suggestive of SVC obstruction. Superior vena cava syndrome was more common in the non-cardiac surgical group (52% vs. 10%, p = 0.001). The mean gradient and SVC diameter improved from 10.8 ± 5.8 mm Hg to 2.6 ± 2.2 mm Hg (p < 0.001) and 3.1 ± 2.7 mm to 9.1 ± 3.8 mm, respectively (p < 0.001). The obstruction was adequately relieved in all 36 patients receiving stents and in 21 of 27 patients (78%) who had balloon dilation alone. Complications occurred in 12 patients (19%), all of whom had previously undergone cardiac surgery; 10 of these patients were successfully treated in the catheterization laboratory. Freedom from re-intervention did not differ between patients undergoing balloon dilation or stent implantation, but was longer in patients age >5 years at the time of intervention.

Conclusions: Superior vena cava-related symptoms occur in only 50% of patients with hemodynamically significant SVC obstruction. Endovascular therapy is successful in relieving the stenosis and associated symptoms with good long-term results.

Abbreviations and Acronyms   ECMO = extracorporeal membrane oxygenation   SVC = superior vena cava