Page 20 - Journal of Structural Heart Disease Volume 3, Issue 6

Case Report
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:176-179
DOI: https://doi.org/10.12945/j.jshd.2017.025.17
Received: May 31, 2017 Accepted: June 29, 2017 Published online: December 2017
Elective Stent Implant in the Obstructed
Vertical Vein of Supracardiac Total Anomalous
Pulmonary Venous Connection Prior to
Operative Repair
Elisa Rhee, MBBCh, BAO1, John P. Breinholt, MD1*
1 Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, United States
Abstract
of TAPVC repair have improved with better control of pulmonary hypertension and preoperative clinical stabilization due to more aggressive medical manage- ment. This case presents an opportunity to consider an elective interventional strategy that palliates the dis- ease to prevent an urgent need for de nitive repair. Copyright © 2017 Science International Corp.
Key Words
TAPVC • Interventional • Obstructed • Vertical vein • Elective
Introduction
Total anomalous pulmonary venous connection (TAPVC) is a rare cardiac defect that comprises 2% of congenital heart disease cases [1]. TAPVC encompass- es di erent anatomic subtypes in which pulmonary veins fail to connect directly to the left atrium and drain to the right atrium via an anomalous venous connection [2, 3]. Supracardiac TAPVC is the most common type, comprising about 45% of cases [2]. A left-sided vertical vein (VV) accounts for 70% of the connections between the pulmonary con uence and the right atrium, and stenosis occurs in approximate- ly 40% of cases [3].
Obstructed TAPVC typically presents with respi- ratory distress secondary to pulmonary congestion,
* Corresponding Author:
John P. Breinholt, MD
Department of Pediatrics
University of Texas Health Science Center at Houston
6410 Fannin Street, Suite 425, , Houston, TX 77030, USA Tel. +1 713 500 5738; E-Mail: john.p.breinholt@uth.tmc.edu
Background: Total anomalous pulmonary venous con- nection (TAPVC) comprises 2% of congenital heart dis- ease cases. Obstructed TAPVC typically presents with respiratory distress secondary to pulmonary conges- tion. We report a case of an infant patient who was elec- tively referred to catheterization for stent placement to relieve vertical vein (VV) stenosis. Our objective was to prevent the emergent need for surgical intervention while allowing additional growth before surgery.
Case Presentation: A 7-day-old, late pre-term, small for gestational age male infant was transferred from an outside institution. He was initially placed on nasal cannula due to oxygen saturation around 80% but pro- gressed to continuous positive airway pressure and had a chest X-ray suggestive of pulmonary edema. Echocar- diography revealed supracardiac TAPVC, a small apical muscular ventricular septal defect, and a moderate se- cundum atrial septal defect. On admission, the patient was clinically stable with a baseline oxygen saturation of 72% on 40% oxygen. Echocardiography con rmed supracardiac TAPVC and also showed an obstruction with a mean gradient of 22 mmHg in the VV. The de- sire to optimize the patient’s clinical stability led to the decision to undergo cardiac catheterization for stent implantation in the VV. Immediately following the pro- cedure, the patient’s hemodynamics improved, with a pressure gradient between the pulmonary venous con- uence and the left innominate vein of 4 mmHg. Conclusions: Over the last decade, surgical outcomes
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