title: Percutaneous closure of a hemodynamically significant connection between the inferior vena cava and the left atrium.
abstract: OBJECTIVE
  A connection between the inferior vena cava (IVC) and the left atrium (LA) can occur as a rare complication after surgical atrial septum defect (ASD) repair. We demonstrate the first case of a percutaneous closure of this connection.
  
  
  RESULTS
  A 67-year-old female was admitted to hospital due to exertional dyspnea. A history of a surgical ASD repair in 1960 and 1966 with a residual shunt was already known. Transesophageal echocardiography and a CT scan revealed a hemodynamically significant drainage of the IVC into the LA. This connection was successfully closed percutaneously with an AMPLATEZR Duct Occluder I (St. Jude Medical, St. Paul, MN). Post-procedural CT-scan and transthoracic echocardiography demonstrated a stable position and there was also no evidence of a residual shunt. The patient reported a significant reduction of exertional dyspnea.
  
  
  CONCLUSIONS
  Percutaneous closure of an IVC to LA connection in this case was safe and feasible. The decision about which device is optimal must be made on an individual basis.
authors.affiliation: Department of Cardiology, Medizinische Klinik I, University of Giessen, Giessen, 35392, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wiebe
authors.affiliation: Department of Cardiology, Medizinische Klinik I, University of Giessen, Giessen, 35392, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.affiliation: Department of Cardiology, Medizinische Klinik I, University of Giessen, Giessen, 35392, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D018570:Risk Assessment; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014682:Vena Cava, Inferior
keywords: AV fistula/AVM; closure; interventional devices/innovation; vena cava