Successful Emergent Aspiration of Thrombus for Postoperative Superior Vena Cava （SVC）Obstruction Presenting Critical SVC Syndrome in Early Infancy

Abstract

We report successful transcatheter aspiration of thrombi combined with percutaneous transluminal angioplasty （PTA）for an infant complicated by superior vena cava （SVC）obstruction in postoperative period presenting critical SVC syndrome. After fetal diagnosis of transposition of the great arteries with restrictive atrial communication, the patient was delivered in the 38^th week and balloon atrial septostomy was performed immediately after birth. However, the patient experienced complications of persistent pulmonary hypertension （PPHN）and presented with severe cyanosis. Extracorporeal membrane oxygenation had been needed for two weeks to eliminate the PPHN. An arterial switch operation （ASO）was performed sixteen days after birth, while pleural effusion persisted after ASO. Severe chylothrax emerged on the thirty-sixth day of life, while central venous pressure was elevated acutely followed by severe edema in the head, neck, and upper limbs, which suggested SVC obstruction. After confirming the complete occlusion of SVC by venography, a Radifocus^® guide wire was passed through the site of occlusion, over which PTA was performed. After PTA, venography showed residual stenosis and thrombi on the vessel wall. We advanced the sheath introducer from right juggler vein to the stenotic site and aspirated the thrombi using the sheath. After removing many thrombi, final venography showed no residual stenosis and thrombi. Fifty-six days after the thrombectomy, venography revealed sufficient patency of the SVC. SVC obstruction in early infancy may be difficult to maintain patency and may require frequent interventions. The combination of PTA and transcatheter thrombectomy may be feasible choices immediately after obstruction of the SVC.