TRANSCATHETER CORRECTION OF SUPERIOR SINUS VENOSUS ATRIAL SEPTAL DEFECT(SVC ASD) WITH PPARTIAL ANAMOLOUS PULMONARY VENOUS DRAINAGE(PAPVC) USING AORTIC STENT GRAFT
Presenter
Radhapriya Yalamanchi, MBBS, DNB Cardiology, Apollo Hospitals, Chennai, TN, India
Radhapriya Yalamanchi, MBBS, DNB Cardiology, Apollo Hospitals, Chennai, TN, India and Refai Showkathali, MRCP(UK)FRCP(LON)FESC, FACC, Apollo Main Hospital, Chennai, Chennai, India
Title
TRANSCATHETER CORRECTION OF SUPERIOR SINUS VENOSUS ATRIAL SEPTAL DEFECT(SVC ASD) WITH PPARTIAL ANAMOLOUS PULMONARY VENOUS DRAINAGE(PAPVC) USING AORTIC STENT GRAFT
Introduction
The sinus venosus atrial septal defect is characterized by deficiency of the common wall between the superior vena cava and the right upper pulmonary vein. Surgical correction is the standard of care until recently. A transcatheter approach using a covered stent deployed in the SVC-RA junction was first published by Garg et al in 2014, having originally been presented during a conference in 2013 by Abdullah et al. Since then this technique has been adapted and modified by many others. The covered stent replaces the deficient posterior wall of the SVC, thereby closing the SVASD and redirecting the anomalous pulmonary veins into the LA behind the stent.We present a case of 28 year old male who presented with SVC ASD in whom successful transcatheter correction was done using aortic stent graft.
Clinical Case
28 year old male presented to us with NYHA Class II dyspnea for 2 years. His ECG was within normal limits. Transthoracic echocardiogram showed dilated Right atrium and ventricle, large SVASD with left to right shunt and mild PAH. After assessing feasibilty for transcatheter closure using balloon occlusion with Z med ballon and confirming drainage of RUPV into LA, he was planned for intervention. Right femoral vein was used for access. Pigtail was placed in the left inominate vein(LIV)and contrast injection taken to delineate LIV-SVC junction for landmark. JR 3.5 catheter was placed in RUPV(right upper pulmonary vein) to assess the venous drainage pre and post closure and monitor pulmonary venous pressures. Right internal jugular vein(RIJV) for bubble contrast injections to confirm no residual shunt post closure of the defect. The procedure was performed under fluroscopic and transesophageal echocardiogram guidance and ENDURANT II aortic stent graft was successfully deployed across the SVASD.Post procedure, RUPV injection confirmed its drainage into LA with only minimal elevation of mean pulmonary venous pressure. Cardiac CT was performed 2 days post closure to confirm stent in situ and also at 3 months follow up.
Discussion
There have been case reports across various countries where , transcatheter correction of SVC defect was done since 2014. Our case is probably the first of its kind, where closure was done using ENDURANT II aortic stent graft from India. This stent graft comes with anchoring pins at the top which provide resistance to stent migration. In selected patients, using two staged procedure for trancatheter closure of SVASD is a safe and feasible option with favorable outcomes.