Secundum Atrial Septal Defect With Interrupted Inferior Vena Cava and Azygos Continuation: Transfemoral Closure in a 3-Year Old Boy

Abstract

A secundum atrial septal defect (ASD 2) was closed percutaneously via the transfemoral approach in a 3-year-old boy with interrupted inferior vena cava and azygos continuation. The procedure was guided by transesophageal echocardiography and fluoroscopy using conscious sedation. Successful transhepatic and jugular accesses in similar patients are described. This is the first pediatric report describing a transfemoral closure of a secundum atrial septum defect via azygos continuation.

How to deal with atrial septal defect closure from right internal jugular vein: Role of venous‐arterial circuit for sizing and over‐the‐wire device implantation

“…In those cases, other venous routes can be used, including the right internal jugular vein. This access has been described in literature in case of interrupted inferior vena cava and vena azygos continuation both in children and adults.…”

Use of steerable delivery catheter to successfully deliver a Ceraflex septal occluder to close an atrial septal defect in a child with interrupted inferior vena cava with azygos continuation

“…Several routes for closure of atrial septal defects in patients with interrupted IVC have been reported. [4][5][6][7][8] This anomaly can occasionally complicate transcatheter intervention by rendering more difficult the usual direct route from the femoral venous access. This has been overcome by use of several reported …”

“…In such cases, successful transhepatic or transjugular access has been described. [1][2][3][4] Jugular venous approach using steerable delivery catheter to facilitate orientation of the device to the atrial septum is described in the present report.…”

“…[9,10] Flosdorff et al reported a successful transfemoral closure in a 3-year-old boy with an 8x10-mm secundum ASD and interrupted IVC with azygos continuation. [4] The authors were the first to demonstrate that percutaneous closure of ASD via azygos continuation is practicable in children. However, the procedure may not be performed when the defect is larger, as a larger delivery catheter is needed, and it may be impossible to advance a larger catheter through the azygos vein.…”

Pediatric cardiology Percutaneous atrial septal defect closure by using jugular venous access in a case with interrupted inferior vena cava

“…It is hard to locate in pulmonary vein by femoral venous approach and deploying the device in the cases with inferior vena continuation to superior vena cava. Although there were few cases reported in the literature like 53 years old patient [ 1 ] and 2 pediatric cases [ 2 ]. In the case of interrupted vena cava, stable wire and sheath positions cannot be performed because of the anatomy of the azygos vein (abrupt 180-degree venous return and 90-degree turn across ASD) and stiffness of wire.…”