PDF(Pubmed)
Abstract：
Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs.
摘要：
在当前十年中，使用覆膜支架经导管封闭上腔静脉（SVC）形式的窦静脉缺损（SVD）正在成为外科手术的替代方法。放置在腔室交界处的覆膜支架为右上肺静脉（RUPV）创建了一个顶部，该顶部停止了从左到右的分流并将静脉重定向到左心房。虽然手术文献清楚地记录了SVC和RUPV狭窄的发生率，窦房结功能障碍,和手术矫正后持续残留的分流器，在这种新的经导管介入治疗后,必须获得关于并发症发生率和随访结局的类似数据.由于三尖瓣前分流的患者通常在临床上无症状，进行矫正主要是为了防止持续的右心容量超负荷并允许心室的重塑。矫正后任何残留的左向右分流将导致持续的右心扩张。残余流动可能来自各种机制，包括缺乏覆膜支架与SVD的自由边缘的并置，织物破损，以及其他右侧肺静脉的持续性异常引流，这些引流在SVC中非常高，或者可能是由于椭圆形窝的共存缺损所致。这篇综述分析了不同的机制，解释了每个人的经食管和血管造影图像，并提供因各种原因量身定制的解决方案。不同的机制需要不同的处理原则。用于来自一个机构的残余分流的解决方案可能不适合于通过另一机构的残余流。彻底的了解将有助于操作员对这些SVD进行有效的干预。
