Iatrogenic atrial septal defect and aortoatrial fistula in a patient with endovascular prosthesis in the inferior vena cava

Percutaneous procedures and endovascular prostheses are becoming increasingly frequent, replacing classic interventions, and new complications are now appearing. We report the case of a liver transplant patient with a stenosis in the anastomosis of the suprahepatic veins to inferior vena cava, treated by self-expanding prosthesis, who developed an aorto-right atrial fistula and an atrial septal defect. Open heart surgery was performed to correct the defects. Transthoracic echocardiogram 1 year later revealed no evidence of residual shunt.     

Left inferior vena cava with renal cell carcinoma

We presented a case of inferior vena cava on the left side diagnosed by abdominal CT scan during the study of a renal cell carcinoma in the right side. This anomaly is very rare but it may suppose a more difficult approach to the nephrectomy.     

Atrial septal defect with drainage of the inferior vena cava into the left atrium

Atrial septal defect (ASD) with drainage of the inferior vena cava (IVC) into the left atrium (LA) is a rare congenital anomaly. Few cases have been reported in the literature. We present a 17-year-old female with an ASD and an anomalous drainage of the IVC into the LA leading to cyanosis since early childhood. Diagnosis was documented by computed tomography (CT) angiography and confirmed intra-operatively. The patient underwent successful surgical correction with an uneventful postoperative course.     

Two cases of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava]

Two women (16-year-old, 54-year-old) of atrial septal defect with absence of right superior vena cava and persistent left superior vena cava were successfully operated on. Electrocardiographic findings show coronary sinus rhythm and atrial fibrillation. When we closed atrial septal defect cannulated to persistent left superior vena cava via the coronary sinus directly, sick sinus syndrome was not appeared postoperatively.     

Left kidney cancer grossly extending into left-sided inferior vena cava of duplicated inferior vena cava

The left radical nephrectomy with tumor thrombectomy in the presence of a duplicated inferior vena cava is of high surgical risk because the venous tumor thrombus renders the anomalous venous structures dilated and tortuous, making injury more likely. We present a case of a left kidney cancer grossly extending into the left side of a duplicated inferior vena cava. What is more important is to bring such an aberrant vascular anatomy with tumor thrombus to the attention of urologists with high-resolution pictorial illustrations.     

Right atrial surgery with unsnared inferior vena cava.

Right atrial procedures require snaring the venous cannulas to prevent air entrapment in the venous line. In particular situations with complex congenital morphology and/or presence of severe pericardial adhesions the right atrial opening without the inferior vena cava cannula in the surgical field and without dissecting and snaring the inferior vena cava itself, might substantially facilitate the surgical technique, provided an adequate venous drainage is assured to avoid flow reduction or circulatory arrest. In several patients with congenital or acquired heart disease with potentially complicated venous drainage, like extracardiac Fontan procedure and tricuspid valve replacement, cardiopulmonary bypass was conducted either on normothermia (congenital lesions) or with mild hypothermia (acquired disease), with 3 l/min per m(2) flow index and venous drainage through femoral vein cannulation. The right atrium was opened without snaring the inferior vena cava, never provoking reduction of the venous drainage nor air locks in the venous line. This approach substantially enhanced the surgical exposure and therefore facilitated the operative technique without any negative consequence to the patients. Right atrial surgery on cardiopulmonary bypass without direct cannulation and snaring of both superior and inferior vena cava is feasible without flow reduction for surgeons taking care of both congenital and acquired cardiac lesions.     

Dual inferior vena cava: two inferior vena cava filters

The formation of the venous drainage system of the human body is a complex process involving structures forming and regressing in a predefined order. Interruption of any one of these steps results in the formation of a congenital anomaly. Knowledge of these anomalies can prevent us from potential serious and sometimes fatal complications. Variations from the normal anatomy of the inferior vena cava (IVC) occur in 3% of the population. The complex embryology of the IVC stems from three pairs of fetal veins: (1) posterior cardinal veins, (2) subcardinal veins, and (3) supracardinal veins. The cardinal veins constitute the main venous drainage system of the embryo. Although venous anomalies are rare, their knowledge is crucial in diagnosis and treatment. These variations should not be mistaken for pathologic finding, but should be viewed as normal findings of abnormal embryogenesis. We present a case here identifying a dual IVC, subsequently leading us to place two IVC filters.     

Left adrenocortical cancer with inferior vena cava tumor thrombus--a case report

An 62-year-old male was admitted to our hospital for an evaluation of high grade fever, body weight loss and lumbago. He was diagnosed as having a left adrenal tumor with intracaval extension and underwent a radical surgery, including resection of the tumor, left kidney, spleen and IVC tumor thrombus. Histopathological diagnosis was adrenocortical carcinoma with tumor thrombus. To our knowledge, our case seems to be the 8th case report of left adrenocortical cancer with tumor thrombus extension into IVC. Average survival of reported cases was about 15 months. At 4 months after surgery, the patient died due to lung metastasis.     

Right atrial myxoma originating from the inferior vena cava

A patient undergoing successful excision of a right atrial myxoma arising from the inferior vena cava is reported. The rarity of this case prompted a review of the literature in which only 2 other patients with a right atrial myxoma originating from inferior vena cava tissue were found.     

Left inferior vena cava and aneurysm of the abdominal aorta

A case of isolated left-sided inferior vena cava, without situs inversus, in a patient with abdominal aortic aneurysm is reported. On the basis of a review of literature, the authors recall the incidence and the embryology of this anomaly, and analyze its surgical implications, with particular reference to abdominal aortic surgery.