Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery

Adrian Fernando Narváez Muñoz; Javier Aristides Rodriguez Herrera; Daniela Albina Ibarra Vargas; Carlos Ivan Soledispa Suarez; Maxwell Ruben Velasco Salazar; Carlos Alfredo Venegas Arteaga

doi:doi:10.11648/j.js.20180606.16

Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery

Adrian Fernando Narváez Muñoz, Javier Aristides Rodriguez Herrera, Daniela Albina Ibarra Vargas, Carlos Ivan Soledispa Suarez, Maxwell Ruben Velasco Salazar, Carlos Alfredo Venegas Arteaga

Published in Journal of Surgery (Volume 6, Issue 6)

Received: 2 December 2018 Accepted: 17 December 2018 Published: 22 January 2019

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Abstract

Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.

Published in	Journal of Surgery (Volume 6, Issue 6)
DOI	10.11648/j.js.20180606.16
Page(s)	173-177
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Vena Cava Superior, Superior Vena Cava Syndrome, Angiography, Stent, Surgical, Tomography, Sinus Venosus Atrial Septal Defect

References

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[2]	Dedeilias P, Nenekidis I, Hountis P, Prokakis C, Dolou P, Apostolakis E, Koletsis EN. Superior vena cava syndrome in a patient with previous cardiac surgery: what else should we suspect? Diagnostic Pathology. 2010; 5:43.
[3]	Diamantini G, Levi Sandri GB, Procacciante F. Unexpected cause of superior vena cava syndrome. Gland Surgery. 2015; 4 (4):359-60.
[4]	Gallo M, Protos AN, Trivedi JR, Slaughter MS. Surgical Treatment of Benign Superior Vena Cava Syndrome. Annals of Thoracic Surgery. 2016; 102 (4):e369-71.
[5]	Kokotsakis J, Chaudhry UA, Tassopoulos D, Harling L, Ashrafian H, Vernandos M, et al. Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature. Journal of Cardiothoracic Surgery. 2014; 9:107.
[6]	Fichelle JM, Baissas V, Salvi S, Fabiani JN. Superior vena cava thrombosis or stricture secondary to implanted central venous access: Six cases of endovascular and direct surgical treatment in cancer patients. Journal de Médecine Vasculaire 2018; 43 (1):20-28.
[7]	Heppel D, Grapow M, Reuthebuch O, Bolliger D, Fassl J. Superior Vena Cava Syndrome Following Mitral Valve Repair. Journal of Cardiothoracic and Vascular Anesthesiology. 2018; 32 (2):938-94128.
[8]	Salavitabar A, Flyer JN, Torres AJ, Richmond ME, Crystal MA, Turner ME, et al. Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single-center experience assessing risk factors and outcomes. Pediatric Transplantation. 2018, 11:e13267.
[9]	Kühn JP, Mensel B, Ewert R, Bollmann T. Interventional treatment of the acute and subacute vena cava superior syndrome. Pneumologie. 2013; 67 (10):573-9.
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[11]	De Raet JM, Vos JA, Morshuis WJ, van Boven WJ. Surgical management of superior vena cava syndrome after failed endovascular stenting. Interactive Cardiovascular and Thoracic Surgery. 2012; 15 (5):915-7.
[12]	Zubair MM, Duran CA, Peden EK. Superior Vena Cava Reconstruction Using Femoropopliteal Vein as a Panel Graft. Annals of Vascular Surgery. 2017; 44:414. e15-414. e18.
[13]	Sfyroeras GS, Antonopoulos CN, Mantas G, Moulakakis KG, Kakisis JD, Brountzos EA, et al. Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology. European Journal of Vascular and Endovascular Surgery. 2017; 53 (2):238-254.

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Adrian Fernando Narváez Muñoz, Javier Aristides Rodriguez Herrera, Daniela Albina Ibarra Vargas, Carlos Ivan Soledispa Suarez, Maxwell Ruben Velasco Salazar, et al. (2019). Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. Journal of Surgery, 6(6), 173-177. https://doi.org/10.11648/j.js.20180606.16

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Adrian Fernando Narváez Muñoz; Javier Aristides Rodriguez Herrera; Daniela Albina Ibarra Vargas; Carlos Ivan Soledispa Suarez; Maxwell Ruben Velasco Salazar, et al. Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. J. Surg. 2019, 6(6), 173-177. doi: 10.11648/j.js.20180606.16

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AMA Style

Adrian Fernando Narváez Muñoz, Javier Aristides Rodriguez Herrera, Daniela Albina Ibarra Vargas, Carlos Ivan Soledispa Suarez, Maxwell Ruben Velasco Salazar, et al. Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. J Surg. 2019;6(6):173-177. doi: 10.11648/j.js.20180606.16

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@article{10.11648/j.js.20180606.16,
  author = {Adrian Fernando Narváez Muñoz and Javier Aristides Rodriguez Herrera and Daniela Albina Ibarra Vargas and Carlos Ivan Soledispa Suarez and Maxwell Ruben Velasco Salazar and Carlos Alfredo Venegas Arteaga},
  title = {Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery},
  journal = {Journal of Surgery},
  volume = {6},
  number = {6},
  pages = {173-177},
  doi = {10.11648/j.js.20180606.16},
  url = {https://doi.org/10.11648/j.js.20180606.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180606.16},
  abstract = {Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.},
 year = {2019}
}

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TY  - JOUR
T1  - Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery
AU  - Adrian Fernando Narváez Muñoz
AU  - Javier Aristides Rodriguez Herrera
AU  - Daniela Albina Ibarra Vargas
AU  - Carlos Ivan Soledispa Suarez
AU  - Maxwell Ruben Velasco Salazar
AU  - Carlos Alfredo Venegas Arteaga
Y1  - 2019/01/22
PY  - 2019
N1  - https://doi.org/10.11648/j.js.20180606.16
DO  - 10.11648/j.js.20180606.16
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 173
EP  - 177
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20180606.16
AB  - Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.
VL  - 6
IS  - 6
ER  -

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Author Information

Adrian Fernando Narváez Muñoz
Javier Aristides Rodriguez Herrera

Department of Cardiology, Hospital de Especialidades Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
Daniela Albina Ibarra Vargas

Department of Cardiology, Hospital de Especialidades Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
Carlos Ivan Soledispa Suarez

Department of Interventional Cardiology, Hospital de Especialidades Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
Maxwell Ruben Velasco Salazar

Department of Cardiovascular Surgery, Hospital de Especialidades Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
Carlos Alfredo Venegas Arteaga

Department of Cardiovascular Surgery, Hospital de Especialidades Dr. Abel Gilbert Pontón, Guayaquil, Ecuador

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APA Style

Adrian Fernando Narváez Muñoz, Javier Aristides Rodriguez Herrera, Daniela Albina Ibarra Vargas, Carlos Ivan Soledispa Suarez, Maxwell Ruben Velasco Salazar, et al. (2019). Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. Journal of Surgery, 6(6), 173-177. https://doi.org/10.11648/j.js.20180606.16

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ACS Style

Adrian Fernando Narváez Muñoz; Javier Aristides Rodriguez Herrera; Daniela Albina Ibarra Vargas; Carlos Ivan Soledispa Suarez; Maxwell Ruben Velasco Salazar, et al. Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. J. Surg. 2019, 6(6), 173-177. doi: 10.11648/j.js.20180606.16

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AMA Style

Adrian Fernando Narváez Muñoz, Javier Aristides Rodriguez Herrera, Daniela Albina Ibarra Vargas, Carlos Ivan Soledispa Suarez, Maxwell Ruben Velasco Salazar, et al. Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery. J Surg. 2019;6(6):173-177. doi: 10.11648/j.js.20180606.16

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@article{10.11648/j.js.20180606.16,
  author = {Adrian Fernando Narváez Muñoz and Javier Aristides Rodriguez Herrera and Daniela Albina Ibarra Vargas and Carlos Ivan Soledispa Suarez and Maxwell Ruben Velasco Salazar and Carlos Alfredo Venegas Arteaga},
  title = {Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery},
  journal = {Journal of Surgery},
  volume = {6},
  number = {6},
  pages = {173-177},
  doi = {10.11648/j.js.20180606.16},
  url = {https://doi.org/10.11648/j.js.20180606.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180606.16},
  abstract = {Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.},
 year = {2019}
}

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TY  - JOUR
T1  - Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery
AU  - Adrian Fernando Narváez Muñoz
AU  - Javier Aristides Rodriguez Herrera
AU  - Daniela Albina Ibarra Vargas
AU  - Carlos Ivan Soledispa Suarez
AU  - Maxwell Ruben Velasco Salazar
AU  - Carlos Alfredo Venegas Arteaga
Y1  - 2019/01/22
PY  - 2019
N1  - https://doi.org/10.11648/j.js.20180606.16
DO  - 10.11648/j.js.20180606.16
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 173
EP  - 177
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20180606.16
AB  - Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.
VL  - 6
IS  - 6
ER  -

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