Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses Daniel Y. Sze, MD, PhDa, Robert.

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Presentation transcript:

Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses Daniel Y. Sze, MD, PhDa, Robert C. Robbins, MDb, Charles P. Semba, MDa, Mahmood K. Razavi, MDa, Michael D. Dake, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 116, Issue 2, Pages 253-261 (August 1998) DOI: 10.1016/S0022-5223(98)70124-2 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Venograms of a 5-year old girl 70 days after heart transplantation for post-Fontan protein-losing enteropathy. A, Superior venacavogram at time of presentation, demonstrating complete occlusion and slow drainage through collateral vessels. B, Reestablishment of rapid, in-line flow after catheter-directed urokinase thrombolysis and placement of a stent. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 253-261DOI: (10.1016/S0022-5223(98)70124-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Venograms of a 47-year-old woman 8 days after heart-lung transplantation for Eisenmenger's syndrome and atrial septal defect. A, Superior venacavogram demonstrating extensive thrombosis of central veins and minimal collateral drainage through mediastinal veins. B, Thrombolysis revealed underlying stenosis, which responded poorly to balloon angioplasty. C, Restoration of flow after placement of a stent. Note right hemothorax, a complication of thrombolysis. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 253-261DOI: (10.1016/S0022-5223(98)70124-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Venograms of a 37-year-old man 11 days after domino heart-lung transplantation for cystic fibrosis. A, Simultaneous bilateral upper extremity venograms demonstrating stasis and central thrombosis with minimal formation of collateral drainage. B, Repeat venograms after mechanical thrombolysis and placement of stents. Inflow of unopacified blood from jugular veins causes dilutional effect on brachiocephalic opacification. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 253-261DOI: (10.1016/S0022-5223(98)70124-2) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 A, Massive plethora of head, neck, and bilateral upper extremities, and distended external jugular vein caused by SVC syndrome in patient 3. B, Patient's appearance before discharge 28 days after thrombolysis. Plethora completely resolved 4 days after thrombolysis and stent placement. (The patient shaved off his beard.) The Journal of Thoracic and Cardiovascular Surgery 1998 116, 253-261DOI: (10.1016/S0022-5223(98)70124-2) Copyright © 1998 Mosby, Inc. Terms and Conditions