Transhepatic Approach for Device Closure of Secundum Atrial Septal Defect in Patient with Interrupted Inferior Vena Cava

Abstract

Transcatheter device closure of secundum atrial septal defect is a well known option since 1974. The procedure is routinely performed through femoral vein approach but rarely inferior venacava (IVC) may be interrupted or blocked so transfemoral approach cannot be an option in these patients. In such rare cases surgical closure can be performed but in cases of percutaneous closure of secundum atrial septal defect the viable options are transjugular and transhepatic routes. We used transhepatic approach in this patient for device closure of secundum atrial septal defect. A 27mm occluder was used for the defect and two flipper free coils were used to seal the tract and there were no major complications. The patient was discharged home after 36 hours of the procedure with normal liver functions and ultrasonography.

Veno-arterial rail and over the wire technique for atrial septal defect closure in a patient with interrupted inferior venae cava

“…Transfemoral access is challenging due to the long course and multiple kinks that may end up with failure and patient's referral for surgery [1] . Transhepatic access needs special training, specific devices to close the catheter track, and carries risks for major complications [3] . Trans jugular approach using a short manually-curved sheath 4, or a patent ductus arteriosus 180-degree curved sheath instead of the standard ASD 45degree sheath has also been described with many difficulties related to stability during the procedure [4] .…”