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[Budd-Chiari syndrome as a late complication following closure of an atrial septal defect]
Insights
Budd-Chiari syndrome can be a late complication after surgical closure of atrial septal defects. This case highlights the need for surgical intervention in such instances.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- A 19-year-old female with a history of surgically closed secundum atrial septal defect developed Budd-Chiari syndrome.
- Oral contraceptive use was initiated 8 months prior to symptom onset.
Observation:
- The patient presented with acute Budd-Chiari syndrome.
- Angiography revealed non-filling of the inferior vena cava and drainage via collateral veins (vena azygos, vena hemiazygos).
Findings:
- Surgical exploration showed a 6 mm occlusion of the inferior vena cava orifice without thrombi.
- The lesion was successfully repaired using atrial and inferior vena cava patches.
Implications:
- Budd-Chiari syndrome is a potential late complication following atrial septal defect closure.
- Surgical correction is demonstrated as an effective treatment for this rare complication.
Abstract:
A case of a Budd-Chiari syndrome in a 19-year-old female patient is reported who had undergone surgical closure of a secundum atrial septal defect 13 years before. 8 months before the development of the Budd-Chiari syndrome she started to take oral contraceptives. The clinical picture of the Budd-Chiari syndrome developed within several days. The inferior vena cava did not fill with contrast dye when an angiography was performed using the right vena iliaca approach. The contrast dye disappeared through collateral veins (vena azygos, vena hemiazygos). After 4 days of treatment with systemic streptokinase she underwent open-heart surgery. The orifice of the inferior vena cava was occluded to a diameter of 6 mm. No thrombi were found. The lesion was corrected with two patches, one in the right atrium and the other in the inferior vena cava. This case report demonstrates that a Budd-Chiari syndrome is a possible late complication after closure of an atrial septal defect which should be treated by surgery.