Abstract
Iatrogenic diversion of the inferior vena cava (IVC) into the left atrium (LA) is usually reported as a rare complication following large posteroinferior atrial septal defect (ASD) surgery. It may cause acute or chronic hypoxemia, and other potentially life-threatening complications such as stroke. We present a case in which the ASD patch straddled the IVC entrance diagnosed immediately by transesophageal echocardiography (TEE) during the period of patient separated from cardiopulmonary bypass, avoiding the related complications. Our report further underlines the important role of TEE to monitor and guide ASD surgical management, especially secundum ASD with inferior extension or inferior sinus venosus defects, for the early diagnosis of iatrogenic surgical errors.
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No one other than the authors contributed substantially to this study or to the drafting of the manuscript. The authors received no funding for this study.
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540_2014_1925_MOESM1_ESM.gif
Clip1: In the ME biatrial view at 75°, an abnormal blood flow from IVC entrance draining to LA. ME = midesophageal, LA = left atrium, RA = right atrium (GIF 709 kb)
540_2014_1925_MOESM2_ESM.gif
Clip2: Tracking the IVC flow from IVC-RA junction, part of the IVC flow was seen draining to the RA and the Eustachian valve was clearly visible. IVC = inferior vena cava. RA = right atrium (GIF 594 kb)
540_2014_1925_MOESM3_ESM.gif
Clip3: Tracking the IVC flow from IVC-RA junction, the other part of the IVC flow draining to LA (white arrow) And we could find that the patch straddled the IVC entrance. IVC = inferior vena cava. RA = right atrium. LA = left atrium (GIF 743 kb)
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Zhang, Y., Song, H., Qiao, X. et al. Detection and diagnosis of iatrogenic inadvertent diversion of partial inferior vena cava into the left atrium by transesophageal echocardiography during large posteroinferior surgical atrial septal defect closure. J Anesth 29, 442–445 (2015). https://doi.org/10.1007/s00540-014-1925-4
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DOI: https://doi.org/10.1007/s00540-014-1925-4