title: Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia.
abstract: Atrial septal defects (ASDs) are a common congenital abnormality, and operative repair is a routine, safe procedure. Diversion of the inferior vena cava (IVC) into the left atrium is an unusual complication following ASD closure. We report a case that illustrates the problem created by this right-to-left shunt. A middle-aged woman underwent ASD repair. She developed hypoxemia postoperatively. A transthoracic echocardiogram confirmed a right-to-left shunt, found only with agitated saline injected into the femoral vein, not into the basilic vein. Surgical reexploration revealed a residual ASD diverting IVC flow into the left atrium, which was repaired with a pericardial patch. Echocardiography with agitated saline injected from the femoral vein is an easy method to diagnose this uncommon complication.
authors.affiliation: Department of Cardiovascular Services, Marshall University School of Medicine, Huntington, West Virginia 25702, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Thompson
authors.forename: Dennis
authors.initials: D
authors.lastname: Moritz
authors.forename: Romaine
authors.initials: R
authors.lastname: Perdue
authors.forename: Silvestre
authors.initials: S
authors.lastname: Cansino
mesh_terms: D000328:Adult; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology*