Inferior Vena Cava Obstruction Following Surgical Repair of a Secundum Atrial Septal Defect

Abstract

Obstruction of the inferior vena cava (IVC) following surgical repair of an atrial septal defect (ASD) is a rare complication. We present the case of a patient who developed IVC obstruction following surgical repair of a large secundum ASD. The diagnostic and management approaches used to care for this patient are discussed. ( Level of Difficulty: Intermediate. )

Da Vinci Anatomy Card #1: The Eustachian Valve and its Implications in Invasive Cardiology and Cardiac Surgery

“…The precise anatomical understanding of the EV and its variants becomes relevant when planning procedures where this structure may interfere with a successful outcome, such as the case beautifully presented by Patel et al. ( 17 ) in this issue of JACC Case Reports .…”

“…Gross anatomy studies have identified the presence of a prominent EV in up to 26% of specimens ( 14 ). A thick ER >4 mm is seen in 24% of the normal population studied using computed tomography scanning ( 15 ), and this EV variant has been cited as a cause for IVC obstruction ( 16 , 17 ) and right-to-left shunting ( 18 ) following surgical repair of atrial septal defects. This occurs when the prominent EV is mistakenly identified intraoperatively as the lower rim of an atrial septal defect and is sutured to the interatrial septum, affecting IVC flow or diverting it into the left atrium.…”