Percutaneous Atrial Septal Defect (ASD) closure technique in case of association with an azygos continuation of the inferior vena cava “case report”
Article Sidebar
Main Article Content
Abstract
Introduction: Atrial Septal Defect (ASD) is the most common congenital heart disease, accessible to percutaneous closure in 90% of cases. The closure procedure is performed usually under local anesthesia and TTE by femoral access. The association of OS-ASD with an azygos continuation of the inferior vena cava is very rare (< 0.1/1000 births) making femoral access impossible. Only a few cases are mentioned in the literature, here we describe the procedure as faithfully as possible.
Important clinical finding: We present a case of a 32-years-old female candidate for percutaneous closure of OS-ASD with right cavity dilatation who present during her procedure an unusual guidewire path suspecting an azygos continuation of the inferior vena cava, confirmed by CT angiography, making impossible the closure via the femoral approach.
Therapeutic intervention: After being confronted with the categorical patient refusal of the surgery, we performed successfully the procedure; one month later; under general sedation by internal jugular approach. We finished with manual compression before extubating the patient.
Outcomes: The follow-up was favorable at the cost of a hematoma at the puncture site and brachial plexus compression, which regressed after 3 days.
Conclusion: We opted for general anesthesia and intubation to guide the procedure by TEE. We placed it in the aorta, which gave us good stability to continue successfully the procedure. We underestimated the risk of complication at the puncture site, which could have been avoided by using a vascular suture device or more prolonged compression.
Main takeaway lesson: Percutaneous closure is the reference treatment for OS-ASD. In case of is associated with an azygos continuation of the inferior vena cava, the right internal jugular vein remains a reasonable approach; it requires discussion and rigorous preparation by the whole team. The management of the puncture site in this situation remains delicate and requires great concentration.
Article Details
Copyright (c) 2022 Zaoui N, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal of Cardiology and Cardiovascular Medicine is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.
License: Copyright © 2017 - 2025 | 
Open Access by Journal of Cardiology and Cardiovascular Medicine is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.
With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.
Compliance 'CC BY' license helps in:
| Permission to read and download | ✓ |
| Permission to display in a repository | ✓ |
| Permission to translate | ✓ |
| Commercial uses of manuscript | ✓ |
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7. doi: 10.1016/j.jacc.2011.08.025. PMID: 22078432.
Naqvi N, McCarthy KP, Ho SY. Anatomy of the atrial septum and interatrial communications. J Thorac Dis. 2018 Sep;10(Suppl 24):S2837-S2847. doi: 10.21037/jtd.2018.02.18. PMID: 30305943; PMCID: PMC6174145.
Ooi YK, Kelleman M, Ehrlich A, Glanville M, Porter A, Kim D, Kogon B, Oster ME. Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison. JACC Cardiovasc Interv. 2016 Jan 11;9(1):79-86. doi: 10.1016/j.jcin.2015.09.028. PMID: 26762915.
Martin SS, Shapiro EP, Mukherjee M. Atrial septal defects - clinical manifestations, echo assessment, and intervention. Clin Med Insights Cardiol. 2015 Mar 23;8(Suppl 1):93-8. doi: 10.4137/CMC.S15715. PMID: 25861226; PMCID: PMC4373719.
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K; ESC Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42(6):563-645. doi: 10.1093/eurheartj/ehaa554. PMID: 32860028.
Egidy Assenza G, Spinardi L, Mariucci E, Balducci A, Ragni L, Ciuca C, Formigari R, Angeli E, Vornetti G, Gargiulo GD, Donti A. Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance. J Cardiovasc Dev Dis. 2021 Jul 3;8(7):78. doi: 10.3390/jcdd8070078. PMID: 34357321; PMCID: PMC8306204.
Chan KC, Godman MJ, Walsh K, Wilson N, Redington A, Gibbs JL. Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart. 1999 Sep;82(3):300-6. doi: 10.1136/hrt.82.3.300. PMID: 10455079; PMCID: PMC1729188.
Harper RW, Mottram PM, McGaw DJ. Closure of secundum atrial septal defects with the Amplatzer septal occluder device: techniques and problems. Catheter Cardiovasc Interv. 2002 Dec;57(4):508-24. doi: 10.1002/ccd.10353. PMID: 12455087.
ASD_Closing-procedure.pdf (iwate-shd.jp)
Yang MC, Wu JR. Recent review of transcatheter closure of atrial septal defect. Kaohsiung J Med Sci. 2018 Jul;34(7):363-369. doi: 10.1016/j.kjms.2018.05.001. Epub 2018 May 30. PMID: 30063008.
Boffa GM, Chioin R, Stritoni P, Daliento L, Congedo E, Sperandeo V, Scognamiglio R. Continuazione azigos o emiazigos della vena cava inferiore. Studio angiografico di 10 casi [Azygos or hemiazygos continuation of the inferior vena cava. An angiographic findings of 10 cases (author's transl)]. G Ital Cardiol. 1980;10(8):1063-8. Italian. PMID: 7461348.
Seshagiri RD, Patnaik AN, Srinivas B. Percutaneous closure of atrial septal defect via transjugular approach with Blockaid device in a patient with interrupted inferior vena cava. Cardiovasc Interv Ther. 2013 Jan;28(1):63-5. doi: 10.1007/s12928-012-0113-4. Epub 2012 Jul 19. Erratum in: Cardiovasc Interv Ther. 2013 Jan;28(1):137. PMID: 22810920.
Oliveira EC, Moura MAG, Almeida JA, Ribeiro ALP, Nascimento BR. Percutaneous closure of ostium secundum atrial septal defect using left internal jugular vein access in a child with situs inversus and absence of inferior caval vein. Cardiol Young. 2019 Oct;29(10):1310-1312. doi: 10.1017/S1047951119002099. Epub 2019 Sep 2. PMID: 31475660.
Ozdemir E, Emren S V, Eren N K, Nazli C, Tokac M. Transjugular closure of ASD in a patient with interrupted inferior vena cava. Int J Cardiovasc Acad. 2018; 4: 15-18.