Interruption Of Inferior Vena Cava Research Articles

Percutaneous Closure of a Patent Foramen Ovale via Left Axillary Vein Approach with the Amplatzer Cribriform Septal Occluder

Percutaneous closure of a patent foramen ovale (PFO) was successfully performed via the left axillary vein in a 52-year-old female with a history of left posterior cerebral artery embolic cerebrovascular accident (CVA) and inferior vena cava (IVC) interruption with a Simon Nitinol Filter precluding standard access via the common femoral vein. Utilizing a 6 French Amplatzer 180 degrees patent ductus arteriosus delivery sheath and a 25-mm Amplatzer Cribriform occluder, the PFO was successfully closed utilizing general anesthesia and transesophageal echocardiography guidance. This case demonstrates the advantages of the axillary vein approach over the internal jugular or hepatic vein approach in patients with anatomy precluding standard percutaneous closure.

A Systematic Approach to the Use of the Multiplanar Display in Evaluation of Abnormal Vascular Connections to the Fetal Heart Using 4-Dimensional Ultrasonography

The multiplanar display is a modality that allows the simultaneous visualization of 3 orthogonal planes from volume data sets obtained with 3- and 4-dimensional ultrasonography. Simultaneous display of standard views used in fetal echocardiography and their orthogonal planes may provide novel ultrasonographic views for examination of the fetal heart and its vascular connections. This study was designed to determine the clinical utility of the multiplanar display in the examination of abnormal vascular connections to the fetal heart. We reviewed 4-dimensional volume data sets, acquired with the spatiotemporal image correlation technique, from patients with abnormal vascular connections to the fetal heart. Multiplanar views of the fetal heart were used to simultaneously display standard planes used in fetal echocardiography and their corresponding orthogonal planes. This study included 4 volume data sets from fetuses with confirmed abnormal vascular connections to the heart, including: (1) an interrupted inferior vena cava with azygos or hemiazygos vein continuation; (2) a persistent left superior vena cava draining into a dilated coronary sinus; and (3) a dilated superior vena cava associated with a thoracic lymphangioma. Simultaneous visualization of orthogonal planes displaying abnormal vascular connections to the fetal heart facilitated identification of the abnormal vessels and their spatial relationships with other vascular structures. Multiplanar imaging can be used to assess abnormal vascular connections to the fetal heart and may provide novel ultrasonographic planes for fetal echocardiography using 3- and 4-dimensional ultrasonography.

Hypoplastic Left Heart Syndrome, Interrupted Inferior Vena Cava, Biliary Atresia

A neonate was diagnosed with hypoplastic left heart syndrome, heterotaxy syndrome, and interrupted inferior vena cava soon after birth. At 6 days old she underwent the Norwood procedure using Sano modification. Postoperatively she had persistent direct hyperbilirubinemia and was diagnosed with biliary atresia for which she underwent a Kasai procedure at 29 days old. At 10 months she underwent the Kawashima procedure. She is now 20 months old and has been thriving without any jaundice. This case report illustrates that even in the presence of major multiple congenital anomalies, staged reconstruction for hypoplastic left heart syndrome can be successfully performed.

The area behind the heart in the four‐chamber view and the quest for congenital heart defects

To evaluate the spectrum of fetal cardiac defects associated with abnormal sonographic findings in the area behind the heart (ABTH) in the four-chamber view. This study included a retrospective review of 393 fetuses with congenital heart defects (CHD) detected in 2003-2005 at our tertiary referral center and a prospective evaluation of 4666 fetal echocardiograms, including 220 cases of CHD, performed between January 2006 and February 2007. The retrospective and prospective groups did not differ significantly with respect to cardiac anomalies or abnormal findings in the ABTH, allowing us to combine the 613 fetuses with CHD investigated over a 50-month period. In the study period, 69 fetuses had abnormalities of the ABTH (75% with major CHD). In 28 fetuses, two equally sized vessels ran behind the heart. Of these, 26 had an interrupted inferior vena cava with azygos continuation and two had total anomalous infracardiac pulmonary venous connection. In 41 fetuses, only one vessel was visualized, but the descending thoracic aorta was positioned contralateral to the cardiac apex. Of these, 29 had levocardia with right descending aorta. All of them had a right aortic arch. The remaining 12 had dextrocardia with left descending aorta. The ABTH in the four-chamber view is easy to evaluate and offers important diagnostic markers for fetal CHD. Thus, it might enhance the screening performance of the four-chamber view. Attention must be paid to the number of vessels behind the heart and their laterality.

P32.15: Prenatal diagnosis and autopsy of a case with polysplenia syndrome

Heterotaxy syndrome is a rare congenital disorder that appears in 2 different types: right isomerism (asplenia syndrome) and left isomerism (polysplenia syndrome). It occurs in approximately 0.8% of patients with congenital heart disease. Characteristics of the disease are an incomplete or inappropriate lateralisation of atria, thoracic organs and abdominal viscera; an associated hydrops can be found. We report a case of a 34-year-old gravida 2, para 1 with sonographic signs of fetal heterotaxy syndrome at the second trimester scan. Ultrasound examination revealed left isomerism with a complex heart anomaly including a ventricular septal defect and atrioventricular block, a hypertrophic cardiomyopathy, a continuing vena azygos and an interrupted inferior vena cava. The fetal liver was located in a central position. The prognosis was even worse due to a generalized hydrops. Because of the diagnosis the woman decided not to continue with the pregnancy. Labor was induced at 24 weeks of gestation after fetocide by intraamniotic instillation of 0.8 mg Digoxin. Postpartal autopsy verified the prenatal diagnosis of ventricular septal defect, left isomerism of the lungs and atrias. It also showed a venoatrial disconnection on the right side with pulmonary venous drainage into the superior vena cava and into the right atrium. In the abdomen an absent retrohepatic vena cava, pancreas in a central position, non-rotation of the intestines and eleven 4 mm-sized spleens on the left side of the body confirmed the prenatal diagnosis of left isomerism. With high resolution ultrasound it is possible to diagnose left isomerism antenatally. Paidopathologic examination is recommended to confirm the diagnosis of this complex congenital anomaly in detail.

Combined Scimitar Syndrome and Interruption of the Inferior Vena Cava Causing Mega-azygous and Hemiazygous Veins

Computed tomography angiography detected scimitar syndrome with venous drainage to the inferior vena cava caudal to an interruption of the inferior vena cava in a 48-year-old woman. The hepatic veins drained to the supra-hepatic portion of the inferior vena cava cephalic to the interruption, which was a short area of atresia. Azygous and hemiazygous veins were massively enlarged since they drained the right lung, abdomen viscera exclusive of the liver and lower extremities. Inferior vena cava interruption by a short, focal atresia has not previously been described. The inferior vena cava immediately caudal to the interruption is presumed to remain patent because of the scimitar vein flow.

Interrupted hepatic inferior vena cava with transhepatic continuations in a scimitar variant

We report a rare case, in which, an interrupted inferior vena cava with anomalous transhepatic continuations is noticed in a variant of scimitar syndrome. The scimitar variant consisting of dextrocardia, hypoplastic right lung and a non-systemically drained meandering right pulmonary vein, which presents the “scimitar sign” on chest radiograph. To our knowledge, such a combination of cardiac and venous anomalies has not been described before.

Results of Inferior Vena Caval Interruption by Greenfield Filter, Ligation or Resection During Radical Nephrectomy and Tumor Thrombectomy

Surgical resection for patients with renal cell carcinoma and venous tumor thrombus may require interruption of the inferior vena cava using a Greenfield filter, ligation or resection. We describe the indications, technique, complications and outcomes of vena caval interruption during nephrectomy with tumor thrombectomy. We identified 160 patients treated for level II-IV tumor thrombus at our institution between 1970 and 2004. Operative reports were reviewed to establish vena caval interruption. All patients who underwent interruption were assessed for postoperative disability according to the American Venous Forum International Consensus Committee. Vena caval interruption was performed in 40 of 160 cases (25%), including 14 level II, 10 level III and 16 level IV thrombi. A total of 34 patients (85%) were symptomatic at presentation. A Greenfield filter was deployed before cavotomy closure in 4 of 160 patients (2.5%) for bland thrombus of the infrarenal vena cava. Vena caval ligation was used for bland thrombus that completely occluded the infrarenal vena cava in 23 of 160 patients (14.4%), while segmental vena caval resection was performed for tumor thrombus growing into the wall of the vena cava or for tumor thrombus that interfaced with bland thrombus in 13 of 160 (8.1%). Postoperatively no case was class 3 disability, 12 of 40 (30%) were class 2, 12 of 40 (30%) were class 1 and 16 of 40 (40%) showed no disability. The need to interrupt the inferior vena cava is not infrequent in patients undergoing radical nephrectomy and tumor thrombectomy, and it may be well tolerated postoperatively. Management should be based on the degree of venous occlusion and the presence of bland thrombus.

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.

1907: The Role of Inferior Vena Caval Interruption During Radical Nephrectomy and Tumor Thrombectomy

1907: The Role of Inferior Vena Caval Interruption During Radical Nephrectomy and Tumor Thrombectomy

Interrupción de la vena cava inferior mediante filtros de inserción percutánea: Indicaciones y resultados en 287 pacientes

Anticoagulation is the treatment of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated or fails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertion of a filter is the most commonly performed procedure. To report the experience with IVC filters. Retrospective review of all medical records and operative protocols of patients subjected to IVC filter implantations. Follow up was performed by telephone contact with the patient, relatives or primary physicians, ambulatory consultation or by death certificates. During the period 1993-2005 we implanted IVC filters on 287 patients, 55.4% male, average age: 62.1 yrs (17-99). Indications for the procedure were DVT or PE and contraindication of anticoagulation in 141 patients (49.1%), DVT or PE and complication of anticoagulation in 65 patients (22.6%), prophylaxis in 39 patients (13.6%), massive PE or poor respiratory function in 31 patients (10.8%), paradoxal emboli in 4 patients (1.4%) and other causes in seven patients. All percutaneous devices were successfully inserted. There was no morbidity or mortality related to the procedure. The most frequent access site was the internal jugular vein (66.6%). In 24 patients (8.4%) the filter was intentionally deployed above the renal veins. Six patients (2.1%) were lost to follow up after discharge. A mean follow up of 41.5 months was achieved. Ninety one patients died, with a 5 years survival of 64.7%. Symptomatic recurrent PE occurred in 6 patients (2.1%) and was the cause of death on 3 of them (1%), DVT has been detected in 22 patients (7.7%) during the follow up period. IVC filter implantation is a safe and effective short and long term measure to prevent PE and its consequences.

A Case of Coarctation of Aorta with Left Isomerism Associated with Inferior Vena Cava Interruption and Polysplenia

A 27-year-old female visited outpatient clinic for the evaluation of palpitation and dyspnea on exertion. Echocardiographic examination including transthoracic and transesophageal echocardiography revealed coarctation of aorta, bicuspid aortic valve, mitral valve prolapse, and sealed-up ventricular septal defect. Further evaluation with computed tomography angiography revealed another combined congenital anomaly of left isomerism with polysplenism and interrupted inferior vena cava and pulmonary embolism with deep vein thrombosis. After corrective surgery for the coarctation, she received anticoagulation therapy for the treatment and the secondary prevention of pulmonary embolism.

Retrievable vena cava filters: clinical experience

To summarize currently available literature regarding indications for inferior vena cava filters, potential problems associated with the different filters available, and the efficacy and safety of retrievable inferior vena cava filters. The placement of permanent filters may present a number of long-term complications such as filter occlusion and an increased risk of recurrent deep vein thrombosis. Furthermore, patients who require inferior vena cava interruption often have short-term contraindications to anticoagulant therapy, and thus only require filters for temporary indications. Four different retrievable filters have recently received approval for temporary insertion, and preliminary data suggest that the use of these filters is associated with a low rate of pulmonary embolism and complications related to filter insertion. Retrieval was uneventful in almost all patients. No randomized clinical trials have yet been performed, and available information is based on the results of either retrospective or prospective cohort studies. Retrievable filters are a very attractive alternative to either permanent or temporary filters when inferior vena cava interruption becomes necessary, thanks to the advantages of very easy management and the possibility of their being left in place for a long time and removed when they become unnecessary.

Resolution of Large Azygos Vein Aneurysm Following Stent-Graft Shunt Placement in a Patient with Ehlers-Danlos Syndrome Type IV

Ehlers-Danlos syndrome (EDS) type IV is a rare connective tissue disorder associated with thin-walled, friable arteries and veins predisposing patients to aneurysm formation, dissection, fistula formation, and vessel rupture. Azygos vein aneurysm is an extremely rare condition which has not been reported in association with EDS in the literature. We present a patient with EDS type IV and interrupted inferior vena cava (IVC) with azygos continuation who developed an azygos vein aneurysm. In order to decrease flow through the azygos vein and reduce the risk of aneurysm rupture, a stent-graft shunt was created from the right hepatic vein to the azygos vein via a transhepatic, retroperitoneal route. At 6 month follow-up the shunt was open and the azygos vein aneurysm had resolved.

Improving Results of the Fontan Procedure in Patients With Heterotaxy Syndrome

The Fontan operation in patients with heterotaxy syndrome has been associated with a poor prognosis. We studied whether the outcome of those patients with heterotaxy syndrome improved compared with those who did not have the syndrome after an extracardiac Fontan operation. A retrospective review was performed on 185 patients who had undergone an extracardiac Fontan operation between 1996 and 2005. Sixty-two of the patients had heterotaxy syndrome (33.5%). Forty-one had right isomerism and 21 had left isomerism. Heterotaxy syndrome was commonly associated with a morphologic right ventricle (59.7%), a common atrioventricular valve (72.6%), an interrupted inferior vena cava (25.8%), a separate hepatic vein (30.6%), and extracardiac pulmonary venous drainage (16.1%). The hospital mortality rate was higher in the heterotaxy syndrome than nonheterotaxy (4.8% vs 2.4%; p = 0.05). Eight-year survivals were 91.9 +/- 3.2% in the nonheterotaxy group and 89.3 +/- 4.2 % in the heterotaxy group (p = 0.39). At 8 years, freedom from reoperation was 90.2 +/- 3.2% in the nonheterotaxy group and 78.5 +/- 6.2% in the heterotaxy group (p = 0.15). The outcomes (other than those of arrhythmia) were no different between the two groups. The incidences of early and late postoperative arrhythmia were 29.0% and 25.4%, respectively, in heterotaxy patients, and 15.4% and 10.8% in nonheterotaxy patients (p < 0.05). Bradyarrhythmia was found to be more common. During follow-up, atrioventricular valve regurgitation of more than mild was more common in heterotaxy patients (33.9% vs 18.9%; p = 0.05). Midterm outcomes after an extracardiac Fontan operation in heterotaxy and nonheterotaxy patients are similar, except arrhythmia and atrioventricular valve regurgitation.

Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

Transcatheter Closure of Patent Ductus Arteriosus and Interruption of Inferior Vena Cava with Azygous Continuation Using an Amplatzer Duct Occluder

Two cases with interrupted inferior vena cava and azygous continuation requiring patent ductus arteriosus (PDA) occlusion per cardiac catheterization are presented. A technique is described enabelmy occlusion of PDA using an Amplatzer ductal occluder despite interruption of inferior vena cava and azygous continuation.

P5-117: Successful abalation of right ventricular outflow tract (RVOT) tachycardia in a patient with dextrocardia and inferior vena cava interruption

A 66 year-old man with history of dextrocardia was admitted with recurrent wide complex tachycardia associated with palpitation and lightheadedness The baseline EKG showed sinus rhythm with QRS axis of +110, inverted P wave in lead I, first degree AV block, and poor developed R wave in left precordial leads. The right precordial leads showed normal progression of R wave. Both repetitive PVCs and sustained VT were recorded, with inferior QRS axis, and morphology similar to LBBB in the right-precordial leads, and transition between V3-V4(Figure).

Holt-Oram Syndrome with Hemiazygous Continuation of Inferior Vena Cava

A rare and previously unreported combination of Holt-Oram syndrome, atrial septal defect, patent ductus arteriosus, isolated left atrial isomerism and inferior vena caval interruption with hemizygous continuation to the left superior vena cava is described.

3-Dimensional Mapping and Radiofrequency Ablation of Atrial Flutter in a Patient with Interrupted Inferior Vena Cava

The presence of isolated interrupted inferior vena cava (IVC) is very rare. Though the occurrence of typical atrial flutter in this setting has recently been described, the use of 3-dimensional activation mapping to aid the management of such patients has not yet been described. We report the successful ablation of this arrhythmia in a 63-year-old woman using the superior route through the internal jugular vein with the help of a mapping system.