Catheterization and Cardiovascular Interventions 84:478 (2014)
Editorial Comment Sinus Venous Defect, New Important Indication For Structural Interventional Cardiology Bernhard Meier* MD
We have just witnessed the introduction of percutaneous repair of a superior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return (PAPVR) by closing the SVASD and plugoccluding the PAPVR [1]. This procedure eliminated the left-to-right shunt and the patient improved clinically without any side effects. Yet, it accepted a potential compromise of pulmonary venous drainage. The right upper pulmonary region no longer drained into the superior vena cava but the blood reached the left atrium only trough collaterals. It had been assumed that the blockage of regional pulmonary venous drainage was going to be clinically silent based on a case report where asymptomatic blockage of regional pulmonary venous drainage had happened accidentally [2]. These cases had been done under local anesthesia without echocardiographic guidance. The case presented by Garg et al. [3] used a more elaborate approach with two catheterization laboratory sessions under general anesthesia and transoesophageal
echocardiographic guidance. In return, a normalization of the pulmonary venous return was achieved that was more similar to what a surgical reconstruction would have effected. The operators have to be commended on even further expanding the potential of interventional cardiology. We now have two options for percutaneous repair of SVASD/PAPVR. There is the one presented earlier and this is the only one for cases with the anomalous pulmonary vein connected to the opposite wall of the superior vena cava or the right atrium. And there is the physiologically optimized technique presented by Garg et al. for cases with a feasible anatomy. Both techniques eliminate the left-to-right shunt and redirect the previously anomalous pulmonary venous blood flow from the right to the left atrium, the first via collaterals and the second via a newly walled channel. REFERENCES 1. Meier B, Gloekler S, Denereaz D, Moschovitis A. Percutaneous repair of sinus venosus defect with anomalous pulmonary venous return. Eur Heart J 2014;35:1352. 2. Praz F, Carlier M, Meier B. Accidental closure of the left upper pulmonary vein with an Amplatzer atrial septal defect occluder. J Invas Cardiol 2012;24:E219–E221. 3. Garg G, Tyagi H, Radha A. Transcatheter closure of sinus venosus atrial septal defect with anomalous drainage of right upper pulmonary vein into superior vena cava-an innovative technique. Cathet Cardiovasc Interv 2014;84:473–477.
Conflict of interest: Speaker and proctor honoraria and research grants to the institution from St. Jude Medical. *Correspondence to: Bernhard Meier, MD, Professor and Chairman of Cardiology, Cardiovascular Department, Bern University Hospital, 3010 Bern, Switzerland. E-mail: [email protected] Received 9 July 2014; Revision accepted 14 July 2014 DOI: 10.1002/ccd.25613 Published online 19 August 2014 in Wiley Online Library (wileyonlinelibrary.com) C 2014 Wiley Periodicals, Inc. V
Editorial Comment Sinus Venous Defect, New Important Indication For Structural Interventional Cardiology Bernhard Meier* MD
We have just witnessed the introduction of percutaneous repair of a superior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return (PAPVR) by closing the SVASD and plugoccluding the PAPVR [1]. This procedure eliminated the left-to-right shunt and the patient improved clinically without any side effects. Yet, it accepted a potential compromise of pulmonary venous drainage. The right upper pulmonary region no longer drained into the superior vena cava but the blood reached the left atrium only trough collaterals. It had been assumed that the blockage of regional pulmonary venous drainage was going to be clinically silent based on a case report where asymptomatic blockage of regional pulmonary venous drainage had happened accidentally [2]. These cases had been done under local anesthesia without echocardiographic guidance. The case presented by Garg et al. [3] used a more elaborate approach with two catheterization laboratory sessions under general anesthesia and transoesophageal
echocardiographic guidance. In return, a normalization of the pulmonary venous return was achieved that was more similar to what a surgical reconstruction would have effected. The operators have to be commended on even further expanding the potential of interventional cardiology. We now have two options for percutaneous repair of SVASD/PAPVR. There is the one presented earlier and this is the only one for cases with the anomalous pulmonary vein connected to the opposite wall of the superior vena cava or the right atrium. And there is the physiologically optimized technique presented by Garg et al. for cases with a feasible anatomy. Both techniques eliminate the left-to-right shunt and redirect the previously anomalous pulmonary venous blood flow from the right to the left atrium, the first via collaterals and the second via a newly walled channel. REFERENCES 1. Meier B, Gloekler S, Denereaz D, Moschovitis A. Percutaneous repair of sinus venosus defect with anomalous pulmonary venous return. Eur Heart J 2014;35:1352. 2. Praz F, Carlier M, Meier B. Accidental closure of the left upper pulmonary vein with an Amplatzer atrial septal defect occluder. J Invas Cardiol 2012;24:E219–E221. 3. Garg G, Tyagi H, Radha A. Transcatheter closure of sinus venosus atrial septal defect with anomalous drainage of right upper pulmonary vein into superior vena cava-an innovative technique. Cathet Cardiovasc Interv 2014;84:473–477.
Conflict of interest: Speaker and proctor honoraria and research grants to the institution from St. Jude Medical. *Correspondence to: Bernhard Meier, MD, Professor and Chairman of Cardiology, Cardiovascular Department, Bern University Hospital, 3010 Bern, Switzerland. E-mail: [email protected] Received 9 July 2014; Revision accepted 14 July 2014 DOI: 10.1002/ccd.25613 Published online 19 August 2014 in Wiley Online Library (wileyonlinelibrary.com) C 2014 Wiley Periodicals, Inc. V
