scholarly journals A case report of pulmonary vein isolation performed in a patient with polysplenia and interrupted inferior vena cava

2021 ◽  
Author(s):  
Kaspars Kupics ◽  
Kristine Jubele ◽  
Georgijs Nesterovics ◽  
Andrejs Erglis
Keyword(s):  
Inferior Vena Cava ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Venous Access ◽  
University Hospital ◽  
Anatomical Variant

Abstract Background Pulmonary vein isolation (PVI) has entrenched itself as one of main approaches for treatment of paroxysmal symptomatic atrial fibrillation (AF). PVI prevents focal triggers from pulmonary veins from initiating AF paroxysms. As standard—PVI is performed through the inferior vena cava (IVC) approach, through the femoral vein. However, there are conditions when this approach is not appropriate or is not available. Case summary We report a case of a 53-year-old male who was referred to Pauls Stradins Clinical University Hospital for PVI due to worsening AF. Due to the rare anatomical variant of the venous system the standard approach to PVI could not be applied. Interrupted cava inferior did not allow for femoral vein and IVC access. We had to figure out a different path—a combination of internal jugular and subclavian veins was used. Transseptal puncture was performed under transesophageal echocardiography (TOE) control with a puncture needle stiletto. Pulmonary veins were isolated successfully, no complications were observed, and the patient was discharged in sinus rhythm. Discussion In some patients PVI cannot be done through the standard IVC approach. In such cases a different venous access must be chosen. Our patient had a rare variant of interrupted IVC and we had to use superior vena cava approach for the procedure. The difficulty of this approach is that procedure instruments are not designed for non-standard venous access, however a combined use of TOE, general anaesthesia and contact force guided ablation has succeeded in isolating patients’ pulmonary veins.

scholarly journals P1732 Congenital absence of the inferior vena cava: challenge for catheter ablation of arrhythmias via the femoral vein approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R S Prisecaru ◽  
C Leatu ◽  
O Purcar ◽  
C Pitis ◽  
V Costache
Keyword(s):  
Catheter Ablation ◽  
Inferior Vena Cava ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Congenital Absence ◽  
Congenital Cardiac Anomalies

Abstract Introduction Congenital anomalies of the inferior vena cava (IVC) are a well described entity. These anomalies include complete absence, partial absence or duplication of the IVC. They are seen more frequently in those with other congenital cardiac anomalies (0.6%–2%). This congenital condition can be discovered incidentally, or due to symptoms of associated congenital heart disease, asplenia, polysplenia, congenital kidney anomalies or deep venous thrombosis. Case report We report the case of a 48 years old man scheduled for pulmonary vein isolation due to persistent atrial fibrillation resistant to antiarhythmic drugs, symptomatic for palpitations and dyspnea on exertion. Transthoracic ecgocardiography showed mild left atrium enlargement, normal systolic LV function and no significant valve disease. The transoesophageal echocardiography revealed dilation of the left atrium and absence of thrombus in the left atrium or left appendage. Multi-slice spiral thoracic computed tomography (MSCT) was also performed before the procedure and revealed absence of the inferior vena cava and significant dilation of the azygos and hemiazygos veins with subsequent drainage into the superior vena cava. Abdominal CT showed also partial situs inversus. Pulmonary vein isolation (PVI) through femoral vein approach was cancelled and the patient was scheduled for remote magnetic navigation PVI through arterial approach. Conclusions Whether the absence of the IVC is an embryonic anomaly or the result of perinatal thrombosis with regression and subsequent congenital absence of the IVC, absence of the IVC creates difficulties for catheter ablation of arrhythmias via the femoral vein approach.

Mitral and Aortic Atresia Associated with Hypoplastic Right Lung, Crossover Segment of Right Lower Lobe, and Anomalous Scimitar-like Right Pulmonary Venous Connection with Inferior Vena Cava: Clinical, Angiocardiographic, and Autopsy Findings in a Rare Case

1998 ◽  
Vol 1 (5) ◽  
pp. 413-419 ◽  
Author(s):  
Ulrike Bartram ◽  
Stella Van Praagh ◽  
John F. Keane ◽  
Peter Lang ◽  
Mary E. van der Velde ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Pulmonary Vein ◽  
Inferior Vena ◽  
Pulmonary Veins ◽  
Left Lung ◽  
Vena Cava ◽  
Lower Lobe ◽  
Aortic Atresia ◽  
Collateral Vein ◽  
The Right

A newborn female infant was found to have a unique and previously unreported group of anomalies: ( 1) mitral and aortic atresia with a highly obstructive atrial septum; ( 2) hypoplasia of the right lung with a crossover segment involving the right lower lobe; ( 3) normally connected pulmonary veins, two from the left lung and one from the right; and ( 4) a large anomalous branch of the right pulmonary vein of scimitar configuration that anastomosed with the normally connected right pulmonary vein and with the inferior vena cava (IVC). The scimitar vein appeared obstructed at its junction with the right pulmonary vein and at its junction with the inferior vena cava within the hepatic parenchyma. To our knowledge, this is the first report of a scimitar-like vein coexisting with mitral and aortic atresia and connecting both with the right pulmonary vein and with the inferior vena cava. The highly obstructed left atrium was partially decompressed by retrograde blood flow via the normally connected right pulmonary vein to the anomalous scimitar venous pathway and thence to the inferior vena cava via a pulmonary-to-IVC collateral vein.

scholarly journals Radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia and interruption of the inferior vena cava: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Xiaofeng Hu ◽  
Shaohui Wu ◽  
Mu Qin ◽  
Weifeng Jiang ◽  
Xu Liu
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Inferior Vena Cava ◽  
High Power ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Transseptal Puncture ◽  
Rf Ablation ◽  
Anatomical Variant

Abstract Background Dextrocardia with interruption of the inferior vena cava (I-IVC) is a very rare anatomical variant. Catheter ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for electrophysiologists. This case report presents a safe, effective, and radiation-free approach for high-power ablation of AF via a superior transseptal approach in patients with dextrocardia and I-IVC. Case summary A 57-year-old man with paroxysmal AF with dextrocardia and I-IVC with azygos continuation was referred to our hospital for radiofrequency (RF) ablation. It was evident that transseptal puncture and pulmonary vein isolation (PVI) would be impossible using an IVC approach via the femoral vein. Therefore, we decided to perform left atrium (LA) ablation via the superior vena cava approach. A phased array intracardiac echocardiography (ICE) catheter was inserted in the right femoral vein. Three-dimensional (3D) anatomical reconstruction of LA, right atrium (RA), and coronary sinus (CS) ostium were performed using ICE with azygos vein and RA imaging. Navigation-enabled electrodes were inserted into annotated CS on cardiac 3D ICE image. The left internal jugular vein was accessed using an SL1 transseptal sheath and Brockenbrough needle. Transseptal puncture was performed under ICE with an RF-assisted approach. We accomplished ablation index guided high-power pulmonary vein isolation using a bi-directional guiding sheath with visualization capabilities and a surround flow contact force-sensing catheter. No complications occurred during or after the procedure. Discussion With the application of multitude of newer technologies, we can accomplish safe, effective, and fluoroscopy-free RF ablation of AF using the superior approach in patients with complex anomaly.

scholarly journals Pulmonary vein isolation in a patient with atrial fibrillation and a filter in the inferior vena cava

2017 ◽  
Vol 3 ◽  
pp. 279-280
Author(s):  
Dariusz Rodkiewicz ◽  
Marek Kiliszek ◽  
Edward Koźluk ◽  
Agnieszka Piątkowska ◽  
Grzegorz Opolski
Keyword(s):  
Atrial Fibrillation ◽  
Inferior Vena Cava ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Inferior Vena ◽  
Vena Cava

Anomalous Drainage of Pulmonary Veins into the Inferior Vena Cava

Radiology ◽  
1960 ◽  
Vol 75 (4) ◽  
pp. 592-594 ◽  
Author(s):  
Walter Koch ◽  
Alfredo Silva
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Pulmonary Veins ◽  
Vena Cava

Gas Tensions in the Lungs and Major Blood Vessels of the Urodele Amphibian, Amphiuma Tridactylum

1971 ◽  
Vol 55 (1) ◽  
pp. 47-61
Author(s):  
DANIEL P. TOEWS ◽  
G. SHELTON ◽  
D. J. RANDALL
Keyword(s):  
Carbon Dioxide ◽  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Blood Vessels ◽  
Pulmonary Vein ◽  
Oxygen Tension ◽  
Inferior Vena ◽  
Vena Cava ◽  
Dorsal Aorta ◽  
Oxygen Tensions

1. Oxygen and carbon dioxide tensions were determined in the lungs and in blood from the dorsal aorta, pulmonary vein, pulmonary artery and inferior vena cava in the intact, free swimming, Amphiuma. At 15° C this animal was submerged for a large part of the time and surfaced briefly to breathe at variable time intervals, the mean period being 45 min. 2. Oxygen tensions in the lungs and in all blood vessels oscillated with the breathing cycles, falling gradually during the period of submersion and rising rapidly after the animal breathed. The absolute level of oxygen tension did not appear to constitute the effective signal beginning or ending a series of breathing movements. 3. A small oxygen gradient existed between lungs and blood in the pulmonary vein immediately after a breath. The gradient increased in size as an animal remained submerged due, it is suggested, to lung vasoconstriction increasing the transfer factor. 4. Blood in the dorsal aorta had a lower oxygen tension than that in the pulmonary vein. A right-to-left shunt occurred as blood moved through the heart. The degree of shunting increased as the animal remained submerged and pulmonary vasoconstriction occurred. Left-to-right shunt was relatively insignificant since oxygen tensions in the inferior vena cava and pulmonary artery were very similar. 5. Carbon dioxide tensions were relatively constant during the breathing-diving cycle since Amphiuma removed almost all of this gas through the skin.

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