SUPERIOR CAVAL VENOUS SYNDROME AFTER ATRIAL SWITCH PROCEDURE - RELIEFOF COMPLETE VENOUS OBSTRUCTION BY GRADUAL ANGIOPLASTY AND PLACEMENT OF STENTS

Superior caval venous syndrome is one of the late problems known to oc cur after Mustard repair of complete transposition. Reoperation may le ave residual stenosis, and carries substantial risk for the patient. I t is now feasible to use intravascular stents to overcome systemic ven ous baffle obstructions, and such an approach is probably more effecti ve. The purpose of our study therefore, was to assess immediate and me dium term results of inserting stents subsequent to gradual balloon en largement of acquired atresia of the intraatrial baffle in patients wh o had undergone an atrial switch operation. We investigated five patie nts with complete obstruction of the superior caval venous-pathway at perforation of the atretic segment was achieved using a guide wire tec hnique. The procedure was successful in all patients. Gradual angiopla sty was performed and intravascular stents were implanted. The pressur e in the superior caval vein dropped to normal values, symptoms improv ed, and the patency of the newly created venoatrial communication was proven at mid-term follow-up. Thus critical obstructions at the superi or caval venous pathway after the Mustard procedure can be reopened by interventional catheterization. Implantation of balloon-expandable in travascular stents is safe and effective in the acute relief of the ob structions, but careful longterm follow-up is mandatory.