Rashid Aamir, Yousuf Qayoom, Mushtaq Zubair, Bilal Syed, Khan Mehraj
Cardiology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, IND.
Paediatrics, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, IND.
Cureus. 2025 Jun 15;17(6):e86046. doi: 10.7759/cureus.86046. eCollection 2025 Jun.
Obstructive total anomalous pulmonary venous connection (TAPVC) is a life-threatening congenital anomaly requiring urgent intervention. A one-month-old, 2.5 kg neonate presented with tachypnea, respiratory distress, lethargy, and 70% oxygen saturation. Echocardiography revealed obstructed supracardiac TAPVC with a 20 mmHg gradient at the pulmonary venous confluence and a 3.5 mm atrial septal defect with right-to-left shunting. Due to the patient's critical condition, palliative stenting of the vertical vein (VV) was performed. Despite significant tortuosity, a Progreat microcatheter successfully crossed the obstruction. Angiography confirmed severe narrowing, and two overlapping stents (6×18 mm and 7×15 mm) were placed, reducing the gradient to 2 mmHg and improving oxygen saturation to 90%. Balloon atrial septostomy was also performed. While the neonate showed initial improvement, the condition worsened due to sepsis, and the infant expired two days later. This case highlights the feasibility of microcatheter-assisted VV stenting as a palliative measure in critically ill neonates with obstructed TAPVC and emphasizes the need for vigilant post-procedural care.
梗阻性完全性肺静脉异位连接（TAPVC）是一种危及生命的先天性畸形，需要紧急干预。一名1个月大、体重2.5千克的新生儿出现呼吸急促、呼吸窘迫、嗜睡，血氧饱和度为70%。超声心动图显示心上型TAPVC梗阻，肺静脉汇合处压力阶差为20 mmHg，伴有3.5毫米的房间隔缺损及右向左分流。由于患者病情危急，对垂直静脉（VV）进行了姑息性支架置入术。尽管血管严重迂曲，一根Progreat微导管仍成功通过梗阻部位。血管造影证实存在严重狭窄，随后置入了两枚重叠支架（6×18毫米和7×15毫米），压力阶差降至2 mmHg，血氧饱和度提高到90%。同时还进行了球囊房间隔造口术。虽然新生儿起初有所改善，但随后因败血症病情恶化，两天后死亡。本病例突出了微导管辅助VV支架置入术作为梗阻性TAPVC危重新生儿姑息治疗措施的可行性，并强调了术后密切监护的必要性。
