Successful Embolization of a Persistent Left Superior Vena Cava Using the Preloading Coil-in-Plug Technique after Glenn Surgery: A Case Report

Abstract

: Background: Systemic venous collaterals after Glenn surgery may cause persistent cyanosis. The coil-in-plug (CIP) technique can provide strong occlusion within a short landing zone. Additionally, the preloading CIP (pCIP) technique, which involves preloading a microcatheter through the Amplatzer vascular plug (AVP) before implantation, may facilitate coil delivery by avoiding the technical difficulty of catheterizing the AVP after deployment. Case Description: A 15-month-old boy with pulmonary atresia with an intact ventricular septum, right ventricle-dependent coronary circulation, left pulmonary artery stenosis, and 22q11.2 deletion syndrome underwent bidirectional Glenn shunt surgery. Postoperative cyanosis persisted. Contrast-enhanced computed tomography revealed a previously unrecognized left superior vena cava draining into the coronary sinus that created a right-to-left shunt. Intervention and Results: Because the target vessel had a short landing zone and tortuous course, embolization was performed using the pCIP technique with an AVP. A guidewire and microcatheter were preloaded through the AVP before insertion, and the assembled system was advanced to the target site. Coils were then deployed into the plug through the retained microcatheter after positioning the AVP and before AVP detachment. Complete angiographic occlusion was achieved without device migration. Conclusions: The pCIP technique may be a useful option for pediatric patients who require secure embolization within a short landing zone.