The Operation and Management of a Case After Diversion of the Inferior Vena Cava into the Left Atrium After the Open Repair of an Atrial Septal Defect

Iatrogenic cyanosis and clubbing: 25 years of chronic hypoxia after the repair of an atrial septal defect

“…Similar earlier cases have been reported with iatrogenic diversion of IVC flow to the LA after a surgical incorporation of the Eustachian valve of the IVC in the repair of a low-lying ASD (1)(2)(3)(4). This complication was more frequent before the use of cardiopulmonary bypass because time limitations were imposed by only hypothermia and no inflow occlusion (5).…”

Complications following closure of atrial septal defects of the inferior vena caval type

“…The occurrence of an inadvertent diversion of the inferior vena cava into the left atrium may present on the operating table or in the immediate postoperative period with severe cyanosis or hypoxia-induced arrhythmias, as in early reports by Bedford et al (1957) and Bjork et al (1958). In these cases there was probably total diversion of inferior vena caval flow into the left heart.…”

“…Although there have been other reports in the literature (Bjork et al, 1958;Clause et al, 1962;Effler and Groves, 1961;Mustard et al, 1964;Osawa, 1968;Staple, Ferguson, and Parker, 1966), it is known that many other unreported cases have occurred. All authors have emphasized that if the inferior vena caval valve is mistaken for the lower margin of the defect and included in the line of suture closure, then this complication will occur.…”

“…1). Bedford et al (1957) and Bjork et al (1958) described the presentation of this complication during or immediately after operation when hypothermia had been used. More commonly, as described by Effler and Groves (1961) and Mustard, Firor, and Kidd (1964), there is an apparently uncomplicated immediate postoperative course with satisfactory, even dramatic, reduction in heart size and pulmonary vascularity, only to be followed by the insidious onset of cyanosis, dyspnoea with effort, and eventually finger clubbing and polycythemia.…”

Identification of Unusual Conditions after Atrial Septal Defect Repair by Systematic Transthoracic Echocardiographic Assessment

“…High index of clinical suspicion is required should patients with low‐lying ASD develop further exercise intolerance and unexplained cyanosis after repair. Only few cases have been reported so far since it was first described in 1958 17 . Associated factors other than low‐lying ASD included large secundum ASD, inferior sinus venosus defect, prominent Eustachian valves, Chiari network, or Thebesian valves 18 .…”