Successful Venoplasty of Superior Vena Cava Stenosis in a Patient with a
Total Artificial Heart after Orthotopic Heart Transplantation due to
Primary Graft Failure
Abstract
Background: With the limited number of available suitable donor hearts
resulting in plateaued numbers of heart transplantations, short- and
long-term mechanical circulatory support devices, including the
implantation of total artificial hearts (TAH) are modalities that are
increasingly being used as treatment options for patients with end-stage
heart failure. The superior vena cava syndrome has been described in
this context in various disease processes. We report successful
venoplasty for superior vena cava syndrome in a patient with a TAH. Case
Presentation: A 65 years old man with a history of non-ischemic
cardiomyopathy had received a left ventricular assist device, and then
two years later underwent orthotopic heart transplantation using the
bicaval anastomosis technique. The post procedural course was
complicated by primary graft failure, resulting in the need for the
implantation of a TAH. About 5 months after the TAH implantation he
started to develop complications such as volume retention, swelling of
the upper extremities, and was diagnosed to have a superior vena cava
syndrome. The patient underwent a successful venoplasty of his superior
vena cava by interventional radiology with resolution of upper body
edema, normalization of renal and liver function. Conclusion: Potential
fatal complications caused by catheter or wire entrapment in the right
sided mechanical valve of a TAH have been reported. We describe a safe
method for the treatment of superior vena cava syndrome in patients with
TAH.