Z Kardiol 94: Suppl 2 (2005)

Stent Therapy for Baffle Stenoses and Concomitant Transvenous Permanent Pacemaker Implantation in Patients Following a Mustard Procedure 
K. Brockmeier1, N. Sreeram2, M. Emmel2
1Abt. Kinderkardiologie, Klinikum der Universität zu Köln, Köln, BusinessLogic.Land; 2Abt. Kinderkardiologie, Klinikum der Universität zu Köln, Köln;
Introduction: Loss of sinus node function is commonly encountered in patients following a previous Mustard procedure for transposition of the great arteries.Permanent pacemaker implantation by the transvenous approach may be complicated by the presence of acquired baffle stenoses. We report on relief of baffle stenosis by stent implantation followed by permanent transvenous pacing.

Patients and Methods: 6 patients (age range 17 to 23 years) with symptomatic sinus node disease (n=5) or sinus and AV node disease (n=1) underwent cardiac catheterization under general anesthesia. Angiography performed via the femoral vein demonstrated a significant (>50%) stenosis of the superior caval limb of the venous baffle. All stenoses were successfully treated by implantation of a Palmaz P308 or P4014 stent mounted either on a 15mm or 20mm diameter balloon, depending on the diameter of the native superior caval vein. Thereafter, via a left subclavian venous approach, permanent pacemaker leads were introduced through the newly dilated lumen, and AAIr (n=5) or DDDR (n=1) pacing successfully accomplished. Stable atrial lead position and acceptable thresholds (>1.5V / 0.4 ms) were achieved in all patients using active fixation leads anchored close to the left atrial appendage. At follow-up all systems are functioning satisfactorily, and none of the patients has clinical evidence of superior vena cava syndrome.

Conclusions: Introducing permanent pacing leads through freshly stented segments of the superior caval vein is feasible, and associated with stable permanent pacing.