Transcatheter correction of SVASD a viable alternative to surgery

Transcatheter correction of the superior sinus venosus atrial septal defect (SVASD) appears to be a viable substitute to surgical treatment in several patients, suggests a recent study.

Forty-eight consecutive adult SVASD patients undergoing assessment for correction were included in this review. Preprocedural evaluation included cross-sectional imaging and ex vivo simulation using printed or virtual 3-dimensional models.

Of the patients, 25 had transcatheter correction, with a further six awaiting stent implantation, and eight deemed to be technically unsuitable.

The procedure consisted of balloon test inflation in the anticipated stent landing zone with simultaneous trans-oesophageal echocardiography and pulmonary venography to confirm defect closure and unobstructed pulmonary venous drainage. This was followed by the placement of a 10-zig covered Cheatham platinum stent.

Stents between 5 and 8 cm long were implanted. Nine patients were implanted with a second, uncovered stent for anchoring. A high-pressure balloon protected the right upper pulmonary vein (RUPV) during stent implantation to prevent pulmonary venous obstruction in four patients.

No deaths were recorded over a median follow-up period of 1.4 years (interquartile range, 0.8–1.7 years). One patient had stent embolization, while another needed draining of the haemopericardium.

Unobstructed pulmonary venous return was confirmed after 3 months via cardiac computed tomography. In addition, one patient presented with a residual shunt at the latest follow-up.

“The SVASD is characterized by deficiency of the common wall between the superior vena cava and the RUPV, which is no longer committed to the left atrium,” the authors explained.