Superior Vena Cava Stenosis Manifesting with Brain Abscess 2 Decades after Atrial Septal Defect Repair

Superior vena cava (SVC) stenosis has been described as a rare complication of atrial septal defect surgical repair, especially for the superior sinus venosus type with partial anomalous pulmonary venous drainage, in which the SVC is surgically manipulated. Contrary to an acute SVC occlusion that manifests with the classic signs and symptoms of SVC syndrome—facial and neck swelling, dyspnea, plethora—an insidious SVC obstruction can go unrecognized because of the development of venovenous collateral circulation. This alternative drainage pathway allows the patient to remain oligo- or asymptomatic for a longer period of time. We report a case of SVC stenosis with development of intrapulmonary venovenous collaterals, first manifesting with a brain abscess 21 years after atrial septal defect repair.