Superior vena cava obstruction after heart transplantation

Abstract

Superior vena cava obstruction can be a serious complication after heart transplantation. A 58-year-old man with ischemic cardiomyopathy underwent orthotopic bicaval heart transplantation. On the 12th postoperative day, one hour after removing the central venous line, he developed sudden onset of facial edema, cyanosis, and tachycardia. Emergency transesophageal echocardiography revealed superior vena caval thrombosis at the site of anastomosis. Considering the risks of surgical reexploration, the superior vena cava was recanalized by stent deployment. All of the patient's symptoms were relieved a few hours after stent placement.

3 Cases of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement

“…Currently, heart transplantation and ventricular assist devices may be used in end-stage heart failure that is unresponsive to interventional treatments. Although bicaval anastomosis during heart transplantation is preferred because of anatomic and hemodynamic benefits, this method effectively limits the distensibility of the SVC to the circumference of the suture line and may precipitate SVC syndrome with post-transplant RVAD use ( 2 ). Although uncommon, iatrogenic injury to the brachiocephalic venous system after heart transplant surgery can also lead to obstructed venous return.…”

Successful venoplasty of superior vena cava stenosis in a patient with a total artificial heart after orthotopic heart transplantation due to primary graft failure

“…3 SVCS is most commonly recognized in patients with malignancies, 4 and has also been reported to be caused by infections, 5 multiple catherization of the venous system, pacemaker placement, and heart transplantation. 3,[6][7][8] Management of SVCS is dependent on the severity of disease as well as underlying etiology. Percutaneous intervention for SVCS is a treatment modality that has provided successful results.…”

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

“…[1][2][3] Transcatheter intervention with implantable stents has been established as a favorable treatment option for SVC obstruction. [2][3][4][5][6][7][8][9][10][11] Pediatric patients may be at greater risk for SVC obstruction due to smaller absolute vessel size, donor-recipient size discrepancy, type of surgical anastomosis, and complex congenital cardiac anatomy. While prior studies address some associations, several important risk factors such as bicaval anastomosis, lower recipient weight, and donor-recipient size discrepancy remain implied rather than statistically examined, either due to lack of patient data from the inherent limitations of registry-based studies or small sample size precluding analysis.…”

“…SVC obstruction is a well‐known complication following OHT in both children and adults, with reports of venous intervention ranging from 1% to 5% . Transcatheter intervention with implantable stents has been established as a favorable treatment option for SVC obstruction . Pediatric patients may be at greater risk for SVC obstruction due to smaller absolute vessel size, donor‐recipient size discrepancy, type of surgical anastomosis, and complex congenital cardiac anatomy.…”