scholarly journals Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Anas Abudan ◽  
Brent Kidd ◽  
Peter Hild ◽  
Bhanu Gupta
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Case Series ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Orthotopic Heart Transplantation ◽  
Eustachian Valve

Abstract Background Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. Case summary Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. Discussion Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.

A Rare Case of Stenosis at the Inferior Vena Cava to Right Atrium Anastomosis After Bicaval Orthotopic Heart Transplantation

2019 ◽  
Vol 23 (4) ◽  
pp. 418-421 ◽  
Author(s):  
Benjamin Abrams ◽  
Jordan Hoffman ◽  
Muhammad Aftab ◽  
Jacob Evers ◽  
Tamas Seres
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Right Atrium ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Surgical Techniques ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Orthotopic Heart Transplantation

Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of the specific surgical techniques employed during OHT.

scholarly journals Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

2019 ◽  
Vol 47 (7) ◽  
pp. 3465-3474
Author(s):  
Guangze Luo ◽  
Hongrui Pan ◽  
Jiaxue Bi ◽  
Yudong Luo ◽  
Jiechang Zhu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Iliac Vein ◽  
Right Atrial ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
The Right

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

scholarly journals Right atrial inflow obstruction of the inferior vena cava due to atrial septal aneurysm and an elongated Eustachian valve

2008 ◽  
Vol 9 (6) ◽  
pp. 861-864 ◽  
Author(s):  
Jeroen Walpot ◽  
Corstiaan Storm ◽  
Johan Bosmans ◽  
Bernard P. Paelinck ◽  
W. Hans Pasteuning ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Atrial Septal Aneurysm ◽  
Eustachian Valve

Inferior Vena Cava Stenosis After Bicaval Orthotopic Heart Transplantation

2019 ◽  
Vol 33 (9) ◽  
pp. 2561-2568 ◽  
Author(s):  
Mark A. Chaney ◽  
Michael E. Lowe ◽  
Mohammed M. Minhaj ◽  
Gianluca Santise ◽  
Eric Jacobsohn
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Orthotopic Heart Transplantation ◽  
Vena Cava Stenosis

scholarly journals Inferior vena cava and right atrial thrombosis in children with embryonal tumors

2021 ◽  
Vol 20 (3) ◽  
pp. 108-115
Author(s):  
D. G. Akhaladze ◽  
K. V. Shatalov ◽  
I. V. Arnautova ◽  
N. N. Merkulov ◽  
D. Yu. Kachanov ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Right Atrial ◽  
Comprehensive Treatment ◽  
Embryonal Tumors ◽  
Tumor Thrombosis ◽  
History Of ◽  
Cardiac Surgeons

Tumor thrombosis of the central venous system in children with embryonal tumors is a rare complication, requiring a comprehensive treatment approach, with chemotherapy and the intervention of a multidisciplinary team of oncologists and cardiac surgeons. The article describes the medical history of a 9-month-old patient with bilateral nephroblastoma and tumor thrombosis of inferior vena cava and right atrium, as well as provides a brief review of the literature. The patient's parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.

scholarly journals Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sneha R. Gadi ◽  
Benjamin K. Ruth ◽  
Alan Johnson ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Unusual Presentation ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Common Phenomenon ◽  
Right Heart

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.

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