PMC9883701_01
Stepwise modified transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage of the right upper pulmonary vein and right middle pulmonary vein. (A) Computed tomography scan depicting superior sinus venosus atrial septal defect with partial anomalous drainage of the right upper pulmonary vein and right middle pulmonary vein into the superior vena cava. (B) 3D reconstruction of computed tomography scan images. (C) 3D transoesophageal echocardiography showing dimensions of the superior sinus venosus atrial septal defect (1.2 x 2.0 cm). (D) 3D transoesophageal echocardiography depicting the anatomical conditions between the interatrial junction, superior sinus venosus atrial septal defect and superior vena cava. (E) Induction of a 2-0 Ethicon  surgical silk stich, which is extracted from RIJV access to allow secure anchoring of the CP stent during balloon expansion. (F) Placement of the custom-made pre-mounted 10-zig/80 mm covered CP stent using a 14-F Check-Flo sheath. (G). Deployment of 10-zig CP stent using a 26 mm BiB  catheter. (H) Flaring of the inferior stent section with a 28 mm/4 cm Z med II balloon. (I) 3D transoesophageal echocardiography confirming adequate apposition of the covered CP stent. (J) 3D transoesophageal echocardiography excluding obstruction of the right pulmonary veins. (K) Venography of the superior vena cava revealing no residual shunt. (L) 3D transoesophageal echocardiography showing adequate position of the CP stent. BiB, balloon in balloon; CP, Cheatham platinum; CT, computed tomography; LA, left atrium; RIJV, right internal jugular vein; RMLP, right middle pulmonary vein; RUVP, right upper pulmonary vein; SVC, superior vena cava; TOE, transoesophageal echocardiography.
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The main steps of the interventional procedure are presented in Figure 1. In two patients, the CP stent was extracted from the RJIV access and a 2-0 Ethicon  surgical silk suture (length: 75 cm; JnJ Medtech, New Brunswick, NJ, USA) was inserted through the superior zig (Figure 1E).