SUPERIOR VENA-CAVA SYNDROME AFTER HEART-TRANSPLANTATION - PERCUTANEOUS TREATMENT OF A COMPLICATION OF BICAVAL ANASTOMOSES

Objectives: Our objectives were (1) to investigate the incidence and c ause of symptomatic superior vena caval anastomotic stenosis and centr al venous thrombosis in patients receiving heart or heart-lung transpl antation and (2) to explore percutaneous methods of thrombolysis and e ndoluminal intervention to treat these complications. Methods: Review of 1016 cases revealed three cases of superior vena cava syndrome, Ana tomy, surgical technique, and medical risk factors were examined. Perc utaneous treatments, including urokinase thrombolysis, mechanical thro mbolysis, balloon angioplasty, and stent placement, were attempted, Re sults: All three of these patients underwent transplantation by means of the bicaval anastomotic technique, In addition, the diameters of th e donor and recipient cavae were grossly mismatched in all three. Sten oses in all three patients were successfully treated percutaneously wi th balloon angioplasty and stent placement. Treatment of the accompany ing large-volume thrombosis was problematic in these patients, and two had hemorrhagic complications of urokinase thrombolysis. A mechanical thrombolysis device was used successfully in the third patient. Concl usions: Anastomotic stricture and central venous thrombosis is an unco mmon complication of the bicaval anastomotic technique of heart and he art-lung transplantation. Discrepancy between donor and recipient cava l diameters appears to be the major risk factor. Endoluminal thromboly sis and stenting provides rapid and enduring relief of symptoms and pr ecludes repeat sternotomy, cardiopulmonary bypass, and general anesthe sia.