Persistent superior vena cava occlusion after arterial switch surgery in a preterm infant: case report

A case report published in BMC Pediatrics describes a male infant born at 33 weeks and 4 days of gestation with complete transposition of the great arteries and an intact ventricular septum. The infant underwent an arterial switch operation on postnatal day 8. The postoperative course was complicated by generalized edema, chylothorax, pericardial effusion, hydrocephalus, severe infection and feeding intolerance. Bedside ultrasound identified catheter-associated superior vena cava thrombosis, while contrast-enhanced computed tomography confirmed complete proximal superior vena cava occlusion and showed collateral vein formation.

Following the imaging findings, the central venous catheter was removed. The infant received unfractionated heparin followed by low-molecular-weight heparin, alongside comprehensive supportive treatment. Over time, the edema, respiratory symptoms and pleural effusion gradually improved. Follow-up imaging, however, continued to show superior vena cava occlusion without anatomical recanalization. Thus, the reported clinical improvement occurred despite persistent vascular obstruction, and the case does not demonstrate that the thrombus had resolved or that the vessel had reopened.

After multidisciplinary review, anticoagulation was discontinued because the obstruction was considered organized and the infant remained clinically stable with adequate collateral venous drainage. The report proposes that catheter-associated superior vena cava obstruction should be considered when infants with central venous catheters develop upper-body edema, chylothorax or other signs consistent with impaired systemic venous return after congenital heart surgery. It also states that imaging assessment and catheter removal are important in this setting, while closely monitored anticoagulation may be considered when catheter-based or surgical intervention is technically unsuitable. These points represent the authors’ interpretation of a single case rather than evidence from a comparative treatment study.

At 11 months of age, telephone follow-up indicated satisfactory feeding, growth and development. The article combines this single-patient case report with a literature review, and the supplied evidence does not provide the methods or results of a systematic review. Its scope is therefore limited by the experience of one preterm infant and the absence of comparative data. The central finding is that symptom improvement and stable development were observed even though imaging showed persistent superior vena cava occlusion with collateral venous drainage, underscoring the need for individualized assessment by a multidisciplinary team.

Subject of Research: Postoperative superior vena cava occlusion and collateral venous drainage in a preterm infant after arterial switch surgery

Article Title: Superior vena cava obstruction syndrome after an arterial switch operation for complete transposition of the great arteries in a preterm infant: a case report and literature review

Article References: Chen, L., Zhong, X., Chen, Y., & Liu, Y. (2026). Superior vena cava obstruction syndrome after an arterial switch operation for complete transposition of the great arteries in a preterm infant: a case report and literature review. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07645-1

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07645-1

Keywords: superior vena cava occlusion, catheter-associated thrombosis, preterm infant, complete transposition of the great arteries, arterial switch operation, pediatric cardiology, anticoagulation, chylothorax, case report, Superior, vena, cava