Transcatheter Superior SVASD With PAPVR Repair Using Custom 8-cm Covered Stent and Superior Locking Technique.

BACKGROUND

Superior sinus venosus atrial septal defects (SVASDs) with partial anomalous pulmonary venous return (PAPVR) are complex interatrial communications typically requiring surgical repair. Transcatheter-based interventions are limited because of the lack of commercially available devices.

CASE SUMMARY: A 54-year-old woman presented with dyspnea and palpitations. Multimodal imaging revealed a superior SVASD with PAPVR from the right upper/middle lobes to the superior vena cava/right atrium junction, causing a significant left-to-right shunt (Qp/Qs of 1.8:1). A transcatheter closure was performed using a custom-manufactured 10 Zig 8-cm Cheatham-Platinum covered stent on a 22 mm × 8-cm balloon-in-balloon. A superior bare-metal anchoring stent was deployed to prevent inferior stent migration during flaring. Postprocedural hemodynamics confirmed significant shunt reduction (Qp/Qs of 1.05:1).

DISCUSSION: Transcatheter closure of a superior SVASD with PAPVR in adults is technically feasible and favorable using custom-manufactured long devices.

TAKE-HOME MESSAGE: Tailoring custom-manufactured devices to patient anatomy provides a novel approach to personalized medicine for percutaneous SVASD/PAPVR repair.