Microcatheter-Assisted Stenting of a Tortuous Obstructed Vertical Vein in a Case of Obstructive Total Anomalous Pulmonary Venous Connection

TL;DR

A microcatheter-assisted stenting technique was used to treat a life-threatening heart defect in a critically ill newborn, showing potential as a palliative option.

Contribution

Demonstrates the feasibility of microcatheter-assisted stenting in a neonate with obstructive TAPVC.

Findings

Microcatheter successfully crossed a severely tortuous and obstructed vertical vein in a neonate.

Stenting reduced the pressure gradient from 20 mmHg to 2 mmHg and improved oxygen saturation.

The neonate's condition deteriorated post-procedure due to sepsis, highlighting the need for careful post-procedural monitoring.

Abstract

Obstructive total anomalous pulmonary venous connection (TAPVC) is a life-threatening congenital anomaly requiring urgent intervention. A one-month-old, 2.5 kg neonate presented with tachypnea, respiratory distress, lethargy, and 70% oxygen saturation. Echocardiography revealed obstructed supracardiac TAPVC with a 20 mmHg gradient at the pulmonary venous confluence and a 3.5 mm atrial septal defect with right-to-left shunting. Due to the patient's critical condition, palliative stenting of the vertical vein (VV) was performed. Despite significant tortuosity, a Progreat microcatheter successfully crossed the obstruction. Angiography confirmed severe narrowing, and two overlapping stents (6×18 mm and 7×15 mm) were placed, reducing the gradient to 2 mmHg and improving oxygen saturation to 90%. Balloon atrial septostomy was also performed. While the neonate showed initial improvement, the condition worsened due to sepsis, and the infant expired two days later. This case highlights the feasibility of microcatheter-assisted VV stenting as a palliative measure in critically ill neonates with obstructed TAPVC and emphasizes the need for vigilant post-procedural care.

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