Connection of the inferior vena cava (IVC) to the left atrium is a rare lesion, the authenticity of which has been doubted [51 despite previous case reports [1, 2, 61. We have recently seen two cases in whom the diagnosis was made at cardiac catheterization and confirmed at surgery .
Case ReportsPatient 1 presented in the first year of life with typical clinical electrocardiogram (ECG) and radiologic features of tetralogy of Fallot, and the diagnosis was confirmed at cardiac catheterization (Table 1) . Complete repair was undertaken in his second year using surface cooling and circulatory arrest with limited cardiopulmonary bypass . The atrial septum was inspected at operation and a patent foramen ovale was identified and sutured, and this was assumed to account for the passage of the catheter from right atrium to left atrium noted at catheterization . The infundibular stenosis was resected and the ventricular septal defect was closed through a right ventriculotomy . The pulmonary valve appeared normal .His postoperative course was satisfactory and he remained asymptomatic for five years . At that time, mild cyanosis was noted on exertion . Physical examination revealed plethora of the mucous membranes, no cyanosis or clubbing, and only a short grade-2/6 ejection systolic murmur at the left sternal border . Chest radiograph appeared normal and the ECG was normal apart from right bundle branch block . Repeat cardiac catheterization was performed (Table 1) Springer-Verlag New York Inc . 1986 gram are illustrated (Figs. I and 2) . Figure 2 shows filling of a morphologic right atrium with minimal right-to-left shunt, and no filling of the IVC . Figure I shows the catheter lying slightly more posteriorly and medially, when the IVC fills and communicates directly to the left atrium .A second operation was performed and on inspection of the right atrium no IVC orifice was seen . However, through an atrial septal defect (ASD) a cannula could be passed from the left atrium to the IVC . The IVC to left atrium channel was laid open and the orifice then sutured at the level of the atria) septum, thus rerouting the IVC return to the right atrium . The pulmonary venous return was normal, so the ASD was closed by direct suture . The postoperative course was uneventful and the child is now asymptomatic.Patient 2 had an episode of pneumonia in the first year of life, and a cardiac murmur was detected then . Thereafter she remained asymptomatic with normal growth, and only at four years was mild cyanosis detected during crying . Physical examination confirmed the presence of plethora and cyanosis, and auscultation revealed fixed splitting of the second sound with grade-3/6 ejection systolic and grade-2/4 middiastolic murmurs at the left sternal border. Chest radiograph showed cardiomegaly with a dilated pulmonary artery and plethoric lung fields, and the ECG was normal . Cross-sectional echocardiogram showed the IVC passing through the right atrium to enter the left atrium, as well as a secundum ASD .Cardiac catheterization ...
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