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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

Part of: Interventional Cardiology Atrial Septal Defect (ASD)

Published online by Cambridge University Press:  02 September 2019

Edmundo C. Oliveira ,
Marco A. G. Moura ,
José A. Almeida ,
Antonio L. P. Ribeiro  and
Bruno R. Nascimento Open the ORCID record for Bruno R. Nascimento [Opens in a new window]
Edmundo C. Oliveira
Affiliation:
Department of Interventional Cardiology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
Marco A. G. Moura
Affiliation:
Department of Interventional Cardiology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
José A. Almeida
Affiliation:
Department of Interventional Cardiology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
Antonio L. P. Ribeiro
Affiliation:
Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil Departamento de Clínica Médica, Faculdade de Medicina daUniversidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
Bruno R. Nascimento*
Affiliation:
Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil Departamento de Clínica Médica, Faculdade de Medicina daUniversidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
*
Author for correspondence: B. R. Nascimento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, room 246, Belo Horizonte, MG, Brazil. Tel: +55 31 33079746; Fax: +55 31 33079437; E-mail: [email protected]
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Abstract

Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.

Keywords

Atrial septal defectpercutaneous interventionaccess siteinternal jugular veinsitus inversus
Type
Brief Report
Information
Cardiology in the Young , Volume 29 , Issue 10 , October 2019 , pp. 1310 - 1312
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Copyright
© Cambridge University Press 2019 

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