title: Identifying diversion of inferior vena cava after repair of atrial septal defect.
abstract: Inadvertent IVC diversion into left atrium is a rare morbidity following ASD repair. Reported risk factors included a large secundum, or low-lying ASD, or inferior sinus venosus defect, and anomalous pulmonary connection into the RA. In our case, transesophageal echocardiogram showed abnormal connection of IVC to LA, but could not be identified owing to limited window. Cardiac CT could offer better anatomic clarification. On contrast transesophageal echocardiogram with agitated saline injected via right femoral vein, an abnormal right-to-left shunt was demonstrated by transit of microbubbles from IVC into LA, while majority of rest entered into the RA. Therefore, we confirm the IVC diversion into LA. Detection of such unusual condition is a challenge due to the fact that special echocardiographic windows are often needed.
authors.affiliation: Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung City, Taiwan.
authors.forename: Yi Wei
authors.initials: YW
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan. leeweichieh@yahoo.com.tw.
authors.forename: Wei Chieh
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan. chuasr409@hotmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chua
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Cardiac computed tomography; Contrast echocardiography; Diversion of inferior vena cava; Post atrial septal defect repair