Balloon Mitral Valvotomy in Pregnant Patient with Anomalous Inferior Vena Cava

Successful balloon valvotomy was performed by the Inoue technique in a pregnant lady with severe mitral stenosis and pulmonary edema. Total pelvic and abdominal shielding was used and a transseptal puncture was carried out through the left femoral vein because of an anatomically anomalous course of the inferior vena cava.

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

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab191 ◽

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.

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Retrograde non trans-septal balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava, left superior vena cava, and hugely dilated coronary sinus

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.25973 ◽

2015 ◽

Vol 86 (7) ◽

pp. 1289-1293 ◽

Cited By ~ 1

Author(s):

Ranjit Kumar Nath ◽

Dheeraj Kumar Soni

Keyword(s):

Inferior Vena Cava ◽

Superior Vena Cava ◽

Coronary Sinus ◽

Mitral Stenosis ◽

Inferior Vena ◽

Superior Vena ◽

Vena Cava ◽

Left Superior Vena Cava ◽

Mitral Valvotomy ◽

Dilated Coronary Sinus

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A case report of pulmonary vein isolation with radiofrequency catheter using superior vena cava approach in patient with paroxysmal atrial fibrillation and inferior vena cava filter

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa562 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Masatoshi Narikawa ◽

Masayoshi Kiyokuni ◽

Junya Hosoda ◽

Toshiyuki Ishikawa

Keyword(s):

Atrial Fibrillation ◽

Inferior Vena Cava ◽

Left Atrium ◽

Inferior Vena ◽

Superior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Transseptal Puncture ◽

Mapping Catheter ◽

Steerable Sheath

Abstract Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

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