Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Does Presence of Bilateral Superior Vena Cava Impact Transcatheter Closure of Sinus Venosus Defects?
СтатьяНазвание и аннотация: Перевод в очереди
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Sagar Pramod, Thejaswi Puthiyedath, Sivakumar Kothandam
Аннотация
BACKGROUND: Bilateral superior vena cava (BilSVC) is common in sinus venosus defects (SVD) and can impact transcatheter closure (TCC) as venacaval diameter is smaller.
METHODS: Between 2015 and 2025, baseline characteristics, post-interrogation feasibility, procedural details, and outcomes of 33 BilSVC cases were compared with 122 single SVC controls after TCC. The interrogation balloon was 4 mm larger than the venacaval diameter in controls but matched the SVD edge-to-right atrial appendage distance measured on computed tomography in BilSVC. Children required > 16 mm stents among controls, whereas smaller diameters were allowed in BilSVC.
RESULTS: Feasibility post-interrogation was 87.8% in controls and 80.5% in cases; the first chosen balloon was appropriate in 68.9% and 45.5%, respectively. While the balloon was downsized in 18.9% controls, 42.4% cases needed upsizing. Success was 96.7% in controls (four embolizations) and 100% in cases. Stent diameter variation between upper and lower ends was less in controls (0.81%) than in cases (0.63%). Stent overlaps successfully managed instability observed in 9% controls and 21.2% cases. After the stenting, a small, insignificant residual shunt was noted in 66.1% controls and 42.4% cases. During a median follow-up of 27 months (1-113 months), asymptomatic stent thrombi were identified in 4.3% of controls and 15.2% of cases and were treated medically. Reintervention rates for residual shunt were similar.
CONCLUSIONS: Post-interrogation feasibility was lower in BilSVC, with frequent balloon upsizing despite imaging predictions. Tapered stent diameters caused instability in BilSVC, even with a long SVC anchor. Residual leak was lower, but thrombosis rates were higher, impacting thromboprophylaxis.
METHODS: Between 2015 and 2025, baseline characteristics, post-interrogation feasibility, procedural details, and outcomes of 33 BilSVC cases were compared with 122 single SVC controls after TCC. The interrogation balloon was 4 mm larger than the venacaval diameter in controls but matched the SVD edge-to-right atrial appendage distance measured on computed tomography in BilSVC. Children required > 16 mm stents among controls, whereas smaller diameters were allowed in BilSVC.
RESULTS: Feasibility post-interrogation was 87.8% in controls and 80.5% in cases; the first chosen balloon was appropriate in 68.9% and 45.5%, respectively. While the balloon was downsized in 18.9% controls, 42.4% cases needed upsizing. Success was 96.7% in controls (four embolizations) and 100% in cases. Stent diameter variation between upper and lower ends was less in controls (0.81%) than in cases (0.63%). Stent overlaps successfully managed instability observed in 9% controls and 21.2% cases. After the stenting, a small, insignificant residual shunt was noted in 66.1% controls and 42.4% cases. During a median follow-up of 27 months (1-113 months), asymptomatic stent thrombi were identified in 4.3% of controls and 15.2% of cases and were treated medically. Reintervention rates for residual shunt were similar.
CONCLUSIONS: Post-interrogation feasibility was lower in BilSVC, with frequent balloon upsizing despite imaging predictions. Tapered stent diameters caused instability in BilSVC, even with a long SVC anchor. Residual leak was lower, but thrombosis rates were higher, impacting thromboprophylaxis.