Iatrogenic diversion of inferior vena cava to the left atrium presented as recurrent foetal loss: a case report

Abstract

Background Iatrogenic diversion of inferior vena cava (IVC) to the left atrium (LA) after atrial septal defect repair (ASD) is an unusual complication. It rarely occurred nowadays due to trans-esophageal echocardiography (TEE) check during surgery, but there are still few numbers of patients who survived from an old operation during childhood and reached adulthood undiagnosed. Case Summary We present a 27 years old female post ASD repair in childhood with a unique presentation of recurrent abortion in adulthood besides exertional dyspnea. A full workup of investigations were normal except for hemoglobin of 21 and oxygen saturation of 70%. TEE revealed abnormal drainage of IVC to the LA. Surgical correction was done to release the IVC opening to drain in the right atrium and the oxygen saturation reached 99% after weaning from the bypass machine. The postoperative course was uneventful and the patient was discharged five days later. Two years later, she got pregnant twice and completed her pregnancies to term with well-developed infants. Discussion The diversion of the IVC may be either complete or partial. Such complications may result in intraoperative death on the table or may present as early desaturation, shortness of breath, cyanosis, and clubbing or it may present with such symptoms in adulthood. Rarely, it may present with cerebral stroke. Our case presented with the unexpected presentation of recurrent abortion. So, even if it is rare, echocardiography should be considered as a workup for recurrent abortion in a patient with a history of congenital heart surgery.