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J Thorac Cardiovasc Surg 1998;116:253-257
© 1998 Mosby, Inc.

Cardiothoracic Transplantation

Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses

From the Division of Cardiovascular and Interventional Radiology^a and Department of Cardiothoracic Surgery,^b Stanford University Medical Center, Stanford, Calif.

Received for publication Feb. 3, 1998. Accepted for publication March 8, 1998. Address for reprints: Daniel Y. Sze, MD, PhD, Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, H3630, Stanford, CA 94305-5450.

Objectives: Our objectives were (1) to investigate the incidence and cause of symptomatic superior vena caval anastomotic stenosis and central venous thrombosis in patients receiving heart or heart-lung transplantation and (2) to explore percutaneous methods of thrombolysis and endoluminal intervention to treat these complications.
Methods: Review of 1016 cases revealed three cases of superior vena cava syndrome. Anatomy, surgical technique, and medical risk factors were examined. Percutaneous treatments, including urokinase thrombolysis, mechanical thrombolysis, balloon angioplasty, and stent placement, were attempted.
Results: All three of these patients underwent transplantation by means of the bicaval anastomotic technique. In addition, the diameters of the donor and recipient cavae were grossly mismatched in all three. Stenoses in all three patients were successfully treated percutaneously with balloon angioplasty and stent placement. Treatment of the accompanying large-volume thrombosis was problematic in these patients, and two had hemorrhagic complications of urokinase thrombolysis. A mechanical thrombolysis device was used successfully in the third patient.
Conclusions: Anastomotic stricture and central venous thrombosis is an uncommon complication of the bicaval anastomotic technique of heart and heart-lung transplantation. Discrepancy between donor and recipient caval diameters appears to be the major risk factor. Endoluminal thrombolysis and stenting provides rapid and enduring relief of symptoms and precludes repeat sternotomy, cardiopulmonary bypass, and general anesthesia.

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