Secundum atrial septal defect with interrupted inferior vena cava and azygos continuation: transfemoral closure in a 3-year old boy

Secundum Atrial Septal Defect Closure via the Transhepatic Approach in a Patient With Situs Ambiguus and a Left-Sided Inferior Vena Cava

Secundum atrial septal defect (ASD) is the most common type of ASD. Symptoms including dyspnea on exertion usually manifest in the third and fourth decade of life. The transcatheter closure is the treatment of choice for secundum ASD. The transfemoral venous approach has been the mainstay. However, this approach can be challenging or impossible in patients with congenital absence or interruption of the inferior vena cava (IVC). The latter has been reported in patients with situs ambiguus and inversus. In this patient population, other forms of venous access such as the transjugular or transhepatic approach are used. We present a unique case of symptomatic secundum ASD in a patient who was incidentally found to have situs ambiguus with a left-sided intact IVC. An initial attempt at the ASD closure via the transfemoral approach was unsuccessful due to acute angulation. A repeat attempt was successful via the transhepatic approach with the guidance of real-time ultrasound, transesophageal echocardiogram, and the involvement of an interventional radiologist. The procedure was well tolerated without any complications. Repeat transthoracic echocardiogram with agitated saline the day after the procedure was negative for interatrial shunting.

Percutaneous atrial septal defect closure through femoral and transjugular approaches in patients with interrupted inferior vena cava

Femoral venous approach is the classic route of percutaneous atrial septal defect (ASD) closure. But in patients with interrupted inferior vena cava (IVC) with azygos continuation the normal connection is lost rendering transcatheter intervention more complicated and innovative approaches should be sought. Transhepatic approach has been used with success but this approach is technically demanding and could lead to major complications. We report successful percutaneous secundum ASD closure in 2 patients with interrupted IVC. Transjugular route was used to close the secundum ASD in a 15-month-old girl. Percutaneous ASD closure through femoral venous route was performed in a 49-year-old woman. We found that both these approaches of percutaneous ASD device occlusion can be performed with success and safety.

<Learning objective: Interrupted inferior vena cava with azygos or hemiazygos continuation is a rare congenital anomaly but potentially complicates the usual percutaneous atrial septal defect (ASD) closure and therefore merits an accurate diagnosis before the procedure. Percutaneous ASD device closure can be performed with success and safety through femoral and transjugular approaches in patients with ostium secundum ASD who present with interrupted inferior vena cava.>

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

Femoral venous approach is the classical route of percutaneous atrial septal defect (ASD) closure. But in certain circumstances alternative routes are used. In this report percutaneous ASD closure in a case with interrupted vena cava by jugular venous approach is discussed. Percutaneous closure through femoral venous route was planned in a 6-year-old girl with ASD. Because of interrupted vena cava the jugular venous route was used. Having knowledge of this anatomical variation is important for interventionalists before performing femoral venous approach. Percutaneous transjugular venous access is a feasible alternative route in paediatric population for ASD closure.