Use of intravascular stents for superior vena caval obstruction after the mustard operation

Obstruction of the systemic venous pathway is a complication in patients who have undergone the Mustard operation for complete transposition of the great arteries. In this report, we discuss intravascular stent placement in three patients for relief of superior vena caval obstruction after the Mustard operation. The clinical history, cardiac catheterization data, and echocardiographic data before and after stent placement are presented for each patient. Overall, four stents were placed. The mean gradients from the superior vena cava to the right atrium before stent placement were 10, 8, and 6 mm Hg, and they decreased to 3, 0, and 1 mm Hg immediately after stent placement. No complications occurred. Doppier echocardiographic assessment of mean gradients before and after stent placement correlated with the mean gradients determined by cardiac catheterization. Intravascular stent placement is effective for relief of baffle obstruction after the Mustard operation. Serial Doppler assessments of the gradient across the stent offer a noninvasive method for followup of these patients.