Percutaneous Transluminal Angioplasty for Low Cardiac Output Syndrome due to Superior vena cava Stenosis with Venous Return Anomaly, after Open Heart Surgery for Pacemaker Lead-Induced Endocarditis

Mizuki Sumi＊,＊＊	Koji Hashizume＊,＊＊	Tsuneo Ariyoshi＊
Seiji Matsukuma＊	Shun Nakaji＊	Kiyoyuki Eishi＊

（Department of Cardiovascular Surgery, Graduate School of Medicine, Nagasaki University＊, Nagasaki, Japan, Department of Cardiovascular Surgery, Nagasaki Harbor Medical Center City Hospital＊＊, Nagasaki, Japan）

We report a case of percutaneous transluminal angioplasty（PTA）treatment for low cardiac output syndrome due to superior vena cava（SVC）stenosis with venous return anomaly. A 69-year-old man was referred to our hospital for surgical treatment of tricuspid valve infective endocarditis due to infected pacemaker leads, which had been implanted for sick sinus syndrome. Preoperative computed tomography indicated polysplenia syndrome-related absence of the hepatic segment of the inferior vena cava（IVC). Preoperative coronary angiography showed a 99% stenosis in the left anterior descending artery and a total occlusion in the right coronary artery. We therefore performed pacemaker system removal, tricuspid valve plasty, coronary artery bypass surgery, and a new pacemaker implantation（epicardial leads). However, over the postoperative course we noted low cardiac output syndrome due to SVC syndrome, which appeared to be aggravated by venous return anomaly from the patient’s absent IVC hepatic segment. Eight days after the surgery we conducted PTA for SVC syndrome, which notably improved the patient’s hemodynamics. The patient recovered and was transferred to a rehabilitation facility 34 days after the surgery.

 

Jpn. J. Cardiovasc. Surg. 45:107-111（2016）

Keywords：polysplenia syndrome;anomalous inferior vena cava with azygos connection;pacemaker lead endocarditis;superior vena cava syndrome;percutaneous transluminal angioplasty