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Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 1998 Aug; Vol. 116 (2), pp. 253-61. - Publication Year :
- 1998
-
Abstract
- Objectives: Our objectives were (1) to investigate the incidence and cause of symptomatic superior vena caval anastomotic stenosis and central venous thrombosis in patients receiving heart or heart-lung transplantation and (2) to explore percutaneous methods of thrombolysis and endoluminal intervention to treat these complications.<br />Methods: Review of 1016 cases revealed three cases of superior vena cava syndrome. Anatomy, surgical technique, and medical risk factors were examined. Percutaneous treatments, including urokinase thrombolysis, mechanical thrombolysis, balloon angioplasty, and stent placement, were attempted.<br />Results: All three of these patients underwent transplantation by means of the bicaval anastomotic technique. In addition, the diameters of the donor and recipient cavae were grossly mismatched in all three. Stenoses in all three patients were successfully treated percutaneously with balloon angioplasty and stent placement. Treatment of the accompanying 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.<br />Conclusions: Anastomotic stricture and central venous thrombosis is an uncommon complication of the bicaval anastomotic technique of heart and heart-lung transplantation. Discrepancy between donor and recipient caval diameters appears to be the major risk factor. Endoluminal thrombolysis and stenting provides rapid and enduring relief of symptoms and precludes repeat sternotomy, cardiopulmonary bypass, and general anesthesia.
- Subjects :
- Adult
Anastomosis, Surgical adverse effects
Female
Follow-Up Studies
Humans
Infant, Newborn
Male
Middle Aged
Phlebography
Plasminogen Activators administration & dosage
Plasminogen Activators therapeutic use
Postoperative Complications
Superior Vena Cava Syndrome diagnostic imaging
Superior Vena Cava Syndrome therapy
Urokinase-Type Plasminogen Activator administration & dosage
Urokinase-Type Plasminogen Activator therapeutic use
Angioplasty, Balloon
Heart Transplantation adverse effects
Stents
Superior Vena Cava Syndrome etiology
Thrombolytic Therapy
Venae Cavae surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0022-5223
- Volume :
- 116
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 9699577
- Full Text :
- https://doi.org/10.1016/s0022-5223(98)70124-2