Interrupted Interrupted Inferior Vena Cava Research Articles

Successful Repair of Esophageal Atresia with Tracheoesophageal Fistula and Interrupted Inferior Vena Cava: A Rare Case Report

【Abstract】Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a congenital anomaly that can present complex surgical challenges, especially when accompanied by rare vascular conditions like an interrupted inferior vena cava (IVC). The division of the azygos vein is a common part of TEF repair, but in the presence of an interrupted IVC, this can lead to life-threatening complications. We report the case of a newborn diagnosed with EA, TEF, and interrupted IVC, successfully treated through thoracotomy. This case underscores the importance of prenatal and postnatal imaging to diagnose vascular anomalies prior to TEF repair, ensuring the preservation of the azygos vein to prevent fatal outcomes. Raising awareness of this rare association is crucial to optimizing surgical planning and outcomes.

Prenatal ultrasonic diagnosis of esophageal atresia and tracheoesophageal fistula combined with interrupted inferior vena cava: a rare case report.

This is an extremely rare case of complicated fetal esophageal atresia (EA) with tracheoesophageal fistula (TEF) and interrupted inferior vena cava (IVC) diagnosed by prenatal ultrsonography and successfully treated with surgical repair. A 35-year-old pregnant woman was referred to our center for prenatal ultrasound, and the fetus was found to have a series of abnormalities, such as an interrupted IVC associated with a dilated azygos vein, an upper neck pouch sign of the thorax, and polyhydramnios. With suspicion of EA with TEF and interrupted IVC, the infant was born at 39weeks of gestation, and successfully underwent the surgical operation. The baby was doing well after 21months of follow-up. It is beneficial for the prenatal ultrasonic diagnosis of EA with TEF in optimizing labor care, postpartum treatment, and prompting neonatal management.

Patent Ductus Arteriosus Device Closure in Interrupted Inferior Vena Cava

Interrupted inferior vena cava (IVC) with azygous continuation provides technical challenge in many percutaneous cardiac interventions. They are performed via the femoral venous access route. We describe four such cases in whom, patent ductus arteriosus (PDA) device closure was done in interrupted IVC. All the four cases were done using the femoral route. Two cases were done via retrograde approach through femoral artery access, in which one was closed with a muscular VSD device and the other with a Gianturco coil.The introduction of newer closure devices helps in the retrograde approach. Two cases were done via anterograde approach through the femoral venous route, with a loop through the azygous vein. One child had transient bradycardia due to cardiac stretch which normalized after the device deployment and introducer system removal.Thus, we describe different femoral approaches in interrupted IVC patients for PDA closure, with the difficulties faced and the complications managed.

Natural History of Kawashima Palliation in Single-Ventricle and Interrupted Inferior Vena Cava Heart Disease in China 11 Years Result

<b>Background:</b> The long-term outcomes of patients treated with a Kawashima procedure and keeping the antegrade pulmonary blood flow (AnPBF) in single-ventricle (SV) and interrupted inferior vena cava (IVC) heart disease is still uncertain as yet. <b>Methods:</b> We investigated 18 patients who underwent the Kawashima procedure with SV physiology and an interrupted IVC between January 2009 and June 2018, perioperative, operative and postoperative characteristics were recorded. <b>Results:</b> A total of 18 patients underwent the Kawashima procedure at a median age of 2.7 years (range 0.5–24.7 years), of which 12 (66.7%) were male and 6 (33.3%) were female. The mean saturation was 76.2 ± 8.5% in preoperative period and 94.2 ± 2.2% in postoperative period. All patients had kept AnPBF. The median duration of mechanical ventilation was 12 h (range 2.5–22.5 h) and the median duration of pleural drainage was 5 days (range 2–27 days). The median hospital stay was 9 days (range 6–70 days). There was no operative death and no mortality was seen in early postoperative period. Follow-up was 100% completed, with an average follow-up period of 6.1 ± 2.7 years (range 1–11 years). 4 patients died during the follow-up. The overall 5 and 10 years’ survival rates estimated by Kaplan-Meier method were 88% and 68%, respectively. Although there were no significant differences in the duration of postoperative follow-up between the death group and the survival group (<i>p</i> > 0.05), the major systemic ventricular end-diastolic diameter (SVEDD) (<i>p</i> = 0.018) and the degree of AVVR (<i>p</i> = 0.001) showed significant difference between the two groups. The diameters of main pulmonary artery showed significant growth in both the death group (<i>p</i> = 0.015) and the survival group (<i>p</i> = 0.012) over time. SVEDD had no significant increase in the survival group (<i>p</i> = 0.665) but was significantly larger in the death group (<i>p</i> = 0.014). Multivariable risk factors of late mortality in patients treated with Kawashima procedure were follow-up AVVR (<i>p</i> = 0.044; HR: 3.124; 95%CI: 1.030–9.473) and SVEDD (<i>p</i> = 0.031; HR: 9.766; 95%CI: 1.226–77.8). 14 patients (100%) were all in New York Heart Association (NYHA) functional class I and the mean saturation was 93 ± 2% at last follow-up. Only one patient finished Fontan completion. <b>Conclusions</b>: The Kawashima procedure with AnPBF can be safely performed with acceptable early and long outcomes. Although some previous studies have shown the risk of pulmonary arteriovenous malformations (PAVMS) after Kawashima procedure in the mid- and long-term, our findings are in contradiction with it. No PAVMs occurred in all the survivors. Kawashima procedure with open AnPBF may be a good option for unsuitable Fontan candidates.

Interrupted inferior vena cava with azygos continuation in an extreme preterm infant: Unusual lower-limb peripherally inserted central catheter line tip position

We report a case of interrupted inferior vena cava (IVC) with azygos continuation in an extremely preterm infant born at 23 weeks of gestation. This anomaly was detected after the insertion of lower-limb peripherally inserted central catheter. The tip of the catheter on lateral chest X-ray was in an unusual position as the catheter continued to run anterior to the spinal vertebrae and posterior to the umbilical arterial catheter within the aorta on two separate insertion attempts. Ultrasound Doppler and echocardiogram confirmed the diagnosis of interrupted IVC with azygos continuation. Neonatal practitioners need to be aware of this anomaly to avoid unnecessary interventions.

Device closure of patent ductus arteriosus in interrupted inferior vena cava

IntroductionA 3-year-old child, weighing 8kg, presented with patent ductus arteriosus (PDA) and interrupted inferior vena cava (IVC). The patient underwent successful PDA device closure via transjugular route after failing attempt at femoral venous route. Case summaryPDA device closure was attempted via femoral venous route but could not be accomplished due to difficult curves to negotiate. Following this, PDA could be closed by device from jugular venous route with ease. DiscussionInterrupted IVC poses challenges for PDA device closure and various alternative routes are described like internal jugular, transhepatic, or femoral venous – azygous route. Our case describes difficulties associated with femoral venous route and advantages of jugular venous route in such cases. ConclusionInternal jugular access is a safe and feasible method of PDA device closure in cases of interrupted IVC even in smaller children.

Preserving the azygos vein when repairing esophageal atresia and tracheoesophageal fistula accompanied by interrupted inferior vena cava

This report describes an infant born with esophageal atresia, tracheoesophageal fistula, right-sided diaphragmatic hernia, and an interrupted inferior vena cava (IVC) that underwent successful repair. The report emphasizes the importance of diagnosing an interrupted IVC prior to tracheoesophageal repair.

Interrupted inferior vena cava: high-risk anatomy for right thoracotomy

Interrupted inferior vena cava (IVC) is a rare developmental defect characterised by azygos continuation following failure of fusion of one or more of the component parts of the embryological IVC and occurring in approximately one in 5000 of the general population. It is usually an isolated finding and generally asymptomatic. We present a case of non-small cell lung cancer requiring right pneumonectomy in a patient with an interrupted IVC with azygos continuation.

Successful Blood Sampling Through Azygos Continuation With Interrupted Inferior Vena Cava A Case Report and Review of the Literature

Interrupted inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, and is frequently associated with other cardiovascular malformations and situs anomalies, such as left isomerism. These patients usually develop deep vein thrombosis (DVT), and asymptomatic patients above 60 years of age are very rare. Here we report a case of interrupted IVC which we diagnosed in a 72-year-old woman. She was admitted to our hospital suffering from heart failure and supraventricular tachycardia. Echocardiography detected secundum atrial septal defect (ASD). An abnormal paravertebral pleural line on the chest X-rays indicated the existence of venous anomaly. Anatomical images obtained by Multidetector Computed Tomography (MDCT) helped us to successfully perform right heart catheterization procedures through azygos continuation including blood sampling from pulmonary veins. Even in elderly patients, a careful examination of chest X-rays can indicate undiagnosed venous anomalies; thus, it is critically important before planning surgical or interventional procedures.

Heterotaxy Syndrome: Defining Contemporary Disease Trends

The purpose of this study was to define a population of visceral heterotaxy and to investigate the incidence of bacterial sepsis in the current era of universal pediatric pneumococcal immunization. Pediatric echocardiography and radiology databases, along with electronic medical records, were searched for patients followed-up since birth between 1999 and 2009 with either asplenia or polysplenia and cardiac anatomy consistent with heterotaxy syndrome. A total of 29 patients were identified. Seven patients (24%) had a total of 8 sepsis events, and 6 patients (86%) developed sepsis while taking appropriately prescribed antibiotic prophylaxis. Of the patients with sepsis, 5 had polysplenia and 2 had asplenia. Sixty-two percent of sepsis events were nosocomially acquired. No cases of pneumococcal sepsis occurred after the introduction of the conjugated pneumococcal vaccination to the pediatric vaccination schedule. Bacterial sepsis was associated with a 44% mortality rate. An unexpected finding in 3 patients with visceral heterotaxy, asplenia, and an interrupted inferior vena cava (IVC) as the only anomaly on echocardiography was associated intestinal malrotation. Children with visceral heterotaxy remain at significant risk of life-threatening bacterial infection. In addition, the finding of interrupted IVC on echocardiography should prompt screening for intestinal malrotation, even in the absence of additional structural heart disease.

Symptomatic interrupted inferior vena cava: report of a case presenting with haematochezia

Interrupted inferior vena cava (IVC) is a rare developmental defect. IVC interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Here, we report the imaging findings of a patient with an interrupted IVC with diffuse collaterals between the infrarenal IVC and large renal veins, left gonadal, and perirectal haemorrhoidal-portal collateral veins with associated haematochezia. Depending on the haemodynamic changes, interrupted IVC may cause possible different clinical findings as presented here.

A novel method to improve prenatal diagnosis of abnormal systemic venous connections using three‐ and four‐dimensional ultrasonography and ‘inversion mode’

The precise prenatal diagnosis of abnormal venous connections of the fetal heart is challenging. Anatomical accuracy may be important in determining the best route for postnatal angiography, as well as the prognosis and treatment. This study was designed to determine the value of 'inversion mode', a new three- and four-dimensional (4D) rendering algorithm, in the visualization of the spatial relationships of an interrupted inferior vena cava (IVC) with azygos or hemiazygos vein continuation associated with and without heterotaxic syndromes. Heart volumes were acquired using 4D ultrasonography and spatiotemporal image correlation in cases of interrupted IVC with azygos/hemiazygos continuation (n = 3). Volume datasets were rendered using the 'inversion mode' algorithm and abnormal images were compared to those generated from a library of normal fetuses. The 'inversion mode' rendering algorithm allowed the visualization of dilated azygos or hemiazygos veins and their spatial relationships with the descending aorta, the aortic arch, the superior vena cava, and the atria in cases of interrupted IVC with and without heterotaxic syndromes. The 'inversion mode' algorithm improves prenatal visualization of both dilated azygos and hemiazygos veins, as well as their spatial relationships with the surrounding vascular structures. This has implications for the accurate prenatal diagnosis and management of neonates with abnormal systemic venous connections.

New approach to the surgical management of pulmonary arteriovenous malformations after cavopulmonary anastomosis

The development of pulmonary arteriovenous malformations after cavopulmonary bypass in patients with congenital heart disease is well documented. We report successful management of pulmonary arteriovenous malformations after cavopulmonary bypass in a patient with an interrupted inferior vena cava (IVC) and multiple hepatic veins utilizing an extracardiac conduit from the hepatic veins to the hemiazygous continuation of the interrupted IVC. This technique, performed without circulatory arrest or an atriotomy, may limit morbidity associated with intracardiac procedures in patients with single ventricle morphology. Furthermore, this case suggests an alternative technique for completion Fontan in patients with an interrupted IVC and multiple hepatic venous drainage.