SELF-EXPANDABLE STENTS FOR RELIEF OF VENOUS BAFFLE OBSTRUCTION AFTER THE MUSTARD OPERATION

Objective-Obstruction of the venous pathways after Mustard repair for transposition of the great arteries is associated with an increased ri sk of arrhythmia and sudden death. The purpose of this study was to as sess the effectiveness of the largest (tracheal 22 x 40 mm) Wallstents in treating baffle obstructions. Design-Retrospective analysis of pat ients with stented venous pathways. Subjects-Eleven patients with baff le obstruction after Mustard repair for transposition of the great art eries. Interventions-Stenoses were dilated with an 18 or 20 mm balloon . However, recoil was noticed in 11 patients: immediately (n = 7) or o n repeat angiography (n = 4). Eighteen stents were implanted (mean (SD )) 18 (3.3) years postoperatively. After dilatation a tracheal Wallste nt (11.5 F) was deployed. Main outcome measures-Relief of obstruction, haemodynamic improvement. Results-In the inferior vena cava, 10 stent s were deployed in seven baffle obstructions with an increase in diame ter from 9.8 (2.4) mm to 16.5 (1.4) mm (p < 0.01) and a mean (SD) pres sure gradient decrease from 5.1 (3.6) mm Hg to 1.4 (2.0) mm Hg; in the superior vena cava, eight stents were implanted increasing the diamet er from 9.1 (3.7) mm to 15.6 (3.8) mm (p < 0.001) with a decrease in m ean pressure gradient from 5.1 (2.7) mm Hg to 1.9 (1.5) mm Hg. No comp lications were experienced during implantation. No anticoagulation was prescribed. During follow up (1.7 (0.6) years; range, 0.9-2.6) no pro blems were noted; five patients were re-catheterised without change in measurements. There was no evidence of peal formation in any of the s tents. Conclusion-It is concluded that Wallstents are safe, easy to us e, and effective in relieving baffle obstruction. Anticoagulation does not seem neccessary.