Diversion of the Inferior Vena Cava Following Repair of Atrial Septal Defect Causing Hypoxemia

Abstract

Atrial septal defects (ASDs) are a common congenital abnormality, and operative repair is a routine, safe procedure. Diversion of the inferior vena cava (IVC) into the left atrium is an unusual complication following ASD closure. We report a case that illustrates the problem created by this right-to-left shunt. A middle-aged woman underwent ASD repair. She developed hypoxemia postoperatively. A transthoracic echocardiogram confirmed a right-to-left shunt, found only with agitated saline injected into the femoral vein, not into the basilic vein. Surgical reexploration revealed a residual ASD diverting IVC flow into the left atrium, which was repaired with a pericardial patch. Echocardiography with agitated saline injected from the femoral vein is an easy method to diagnose this uncommon complication.

Percutaneous closure of a hemodynamically significant connection between the inferior vena cava and the left atrium

“…The current treatment of choice would have been another surgical repair [1][2][3]. We describe the first case in which a connection between the IVC and the LA was closed percutaneously.…”

“…There are only few cases known in which drainage of the IVC into the LA after surgical repair of an inferior ASD has occurred [1][2][3][4]. An explanation is that a prominent Eustachian valve was unintentionally included into closure.…”

“…A rare complication after surgical atrial septal defect (ASD) repair is drainage of the inferior vena cava (IVC) into the left atrium (LA), which has been described only anecdotally in case reports [1][2][3][4]. We present the first documented case in which a connection between the IVC and the LA was closed percutaneously.…”

Surgical repair of diversion of inferior vena cava into the left atrium nine years after surgical repair of atrial septal defect

“…(3) Reported factors associated with this complication include a large secundum defect or sinus venosus defect, and anomalous pulmonary return into the RA. (4) In our case we observed that the inferior rim of the defect was not included in the first surgical closure. In addition; there was a scar tissue covering the upper part of the IVC on the RA surface so we believe that there was partial diversion of the IVC at first and by healing process complete diversion of the cava occurred gradually.…”

Diversion of the Inferior Vena Cava Into the Left Atrium After Surgical Repair of Atrial Septal Defect

“…The symptoms of this complication generally appear soon after surgery when the patient becomes cyanotic and hypoxic; however, some factors such as the relief of pulmonary venous congestion and right ventricular strain by the correction of the left-to-right shunt, the occurrence of only partial diversion of the IVC flow to the LA, and the occurrence of stenosis of the IVC, with collaterals draining to the SVC through an azygos vein may contribute to the appearance of the symptoms of this complication later in life (3) . Reported factors associated with this complication include a large secundum defect or sinus venosus defect, and anomalous pulmonary return into the RA (4) . Cannulation of the IVC and SVC through the auricle of the right atrium may play a role in increasing the risk of diversion of the IVC into the LA, especially in IVC type ASD.…”