Endovascular Treatment for Superior Vena Cava Occlusion or Obstruction in a Pediatric and Young Adult PopulationA 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
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Figure 1 Complete SVC Occlusion in a 29-Year-Old Patient With Mustard Operation Who Presented With Nonsustained Ventricular Tachycardia
The superior vena cava (SVC) was found to be occluded (left, arrow) on magnetic resonance imaging and was recanalized with placement of a Genesis XD stent. The patient developed hemothorax during the procedure, which was managed with drainage and placement of a second covered stent (right). MPA = main pulmonary artery.
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Figure 2 Complete Superior Vena Cava Occlusion in a 36-Year-Old Patient With Mustard Operation and Pacing Lead In Situ, Who Presented With Near Syncopal Episodes and Exercise Intolerance
The obstruction (left, arrow) was relieved after placement of 3 Palmaz stents (right). A new pacing system was inserted a few days later.
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Figure 4 Kaplan-Meier Plot Showing Effect of PatientAge on Freedom From Reintervention
Patients >5 years of age at time of intervention had longer freedom from re-intervention (p < 0.001).
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Figure 5 Intimal Proliferation in Stent
Intimal proliferation was identified 10 months after placement of a Palmaz stent (left panel, arrows) in a 6-month-old infant with superior vena cava (SVC) occlusion as a result of extracorporeal membrane oxygenation cannulation. The obstruction was successfully balloon dilated at re-intervention (right panel).
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