Preoperative palliation of newborn obstructed total anomalous pulmonary venous connection by endovascular stent placement

Abstract

Patients with obstructed total anomalous pulmonary venous connection (TAPVC) usually present critically ill and continue to be extremely challenging with presurgical stabilization. We present an extra corporeal membrane oxygenation (ECMO)-dependent neonate with obstructed TAPVC that was successfully palliated with transvenous stent placement in the obstructed vertical vein.

The use of small stents to delay surgical intervention in very young children with critical congenital heart disease

“…Reported success rate ranges between 80% -100%. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Our findings compare favourably with this. Overall, low periprocedural complication rates have been reported in stents used in older children (up to 16%).…”

“…However, as the group of patients is quite diverse, it is difficult to compare the overall mortality to a similar surgical series. (3)(4)(5)(6)(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Mortality in surgical COA repairs in infants for example, is known to be much lower (<2%), but higher in small, complex patients (5 -25%). (3,12) It should be mentioned that one patient was sent home for palliative care and one patient had severe post-operative hypoxia and acidosis.…”

“…(14) Experience in stenting very young and small patients with critical obstructive congenital heart disease is limited and consists mostly of case reports and a few review articles. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) The majority reported good immediate results, but limited data on follow-up and final outcomes is available.…”

Successful stenting of the ductus venosus in 2 neonates with asplenia syndrome complicated by infracardiac type total anomalous pulmonary venous connection

“…Therefore, an alternative method is required in order to treat TAPVC in the neonatal period. Catheter intervention is one of the most important treatments in complex heart diseases [7,9]. Our novel strategy, stent implantation in the DV, is effective and less invasive than early surgery.…”

“…Patients with obstructed TAPVC, especially of the infracardiac type, usually present with critical illness. This requires alternative and aggressive management strategies, for instance, a stent implantation to maintain the pulmonary venous drainage and stable hemodynamics in the neonatal period or early infancy [2,7].…”