Successful balloon angioplasty for inferior vena cava-right atrium anastomotic stenosis following orthotopic heart transplantation

Stenosis formation at anastomotic sites following cardiac transplantation is a rare complication. These strictures can be overcome surgically or percutaneously. A 54-year-old man underwent orthotopic heart transplantation for end-stage dilated cardiomyopathy. Size mismatch between the recipient and the donor resulted in a tight bicaval anastomosis. After seven days postoperatively, the patient developed significant bilateral leg edema. On the tenth postoperative day, he underwent right heart catheterization, and with the injection of contrast material, a stricture was noted at the anastomotic line between the inferior vena cava and the right atrium. The mean pressure gradient at the level of the stenosis was 8 mmHg. The stenotic segment was dilated using a Tyshak II percutaneous valvuloplasty catheter. At the end of the procedure, the mean pressure gradient decreased to 2 mmHg and dilatation was confirmed by venography. Leg edema diminished a few days after the procedure. Hence, the use of a pulmonary balloon catheter for stenotic lesions at the level of anastomosis line between the inferior vena cava and the right atrium yielded a desirable result.