J Transcat Intervent.2020;28:eA2020000007.
Transcatheter occlusion of sinus venosus atrial septal defect – a new therapeutic option?
Francisco Chamié
, Daniel Peralta
, Romulo Torres
, João Carlos Tress
, Maximiliano Otero Lacoste
DOI: 10.31160/JOTCI202028A20200007
ABSTRACT
Background
Percutaneous treatment for atrial septal defects is utilized worldwide as first-line therapy. Its use is restricted to atrial septal defects localized within the confines of the oval fossa. All other atrial septal communications are, traditionally, submitted to surgery. Sinus venosus atrial septal defect is the second most frequent type of atrial septal defects. The diameters are usually large and thus prone to right heart overload. Besides that, it is difficult to be diagnosed by transthoracic echocardiography, and often discovered at an advanced age. Sinus venosus atrial septal defect patients are usually referred to surgical repair, because of unfavorable anatomic characteristics that prevent the use of atrial septal dedicated nitinol mesh devices. The objective of this article is to present a new transcatheter technique for occlusion of sinus venosus atrial septal defect of the superior vena cava.
Methods
All patients were selected by transesophageal echocardiography images and, after informed consent, were sent to attempt transcatheter occlusion. Procedures were performed under general anesthesia and orotracheal intubation. Pressure tracings were obtained by right and left chamber catheterization. Selective contrast angiograms were performed in superior vena cava and right upper pulmonary vein. Simultaneous right upper pulmonary vein selective angiography was obtained after superior vena cava occlusion with large sizing balloons. The patients presenting persistent pulmonary vein flow to left atrium, despite superior vena cava occlusion, were submitted to sinus venosus atrial septal defect closure by covered stents, implanted in the superior vena cava to repair the defect.
Results
Four patients (two males) were selected for occlusion procedures. Age ranged from 30 to 53 years. Implant was possible in 50% of patients. In the remainder, superior vena cava occlusion showed right upper pulmonary vein flow stoppage at that level. The procedure was interrupted and patients electively sent to surgery. There were no residual shunts in patients treated, nor procedural complications.
Conclusion
Transcatheter occlusion of sinus venosus atrial septal defect is an appealing alternative to surgery. Longer follow-up and larger number of cases are warranted for establishing the efficacy and safety of this procedure.
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