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Inferior-to-Superior Vena Cava Bypass for Baffle Stenosis After Atrial Switch
Moyu Hasegawa1, Yuji Tominaga1, Takuji Watanabe1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
This case study details a rare late complication of atrial switch surgery for transposition of the great arteries. A successful inferior vena cava bypass restored liver function after hepatocellular carcinoma.
Area of Science:
- Cardiology
- Hepatology
- Surgical Innovation
Background:
- A patient underwent an atrial switch operation for transposition of the great arteries in infancy.
- Long-term follow-up revealed good cardiac function.
- Hepatocellular carcinoma diagnosis at age 39 prompted re-evaluation.
Observation:
- Severe inferior vena cava baffle stenosis was identified as a potential cause of liver cirrhosis and hepatocellular carcinoma.
- The stenosis likely led to liver congestion.
- A ruptured hepatocellular carcinoma necessitated intervention.
Findings:
- A partial hepatectomy was performed.
- An inferior vena cava-to-superior vena cava bypass was successfully implemented without cardiopulmonary bypass.
- Postoperative liver enzyme levels normalized.
Implications:
- This demonstrates a viable surgical solution for complex postoperative complications.
- Inferior vena cava baffle stenosis is a potential long-term risk after atrial switch procedures.
- Successful management of both cardiac and hepatic complications was achieved.
Abstract:
An atrial switch operation was successfully performed in an 11-month-old patient with transposition of the great arteries. Good cardiac function was noted on regular follow-ups. A severe inferior vena cava baffle stenosis was detected after a ruptured hepatocellular carcinoma at the age of 39 years. Liver cirrhosis and hepatocellular carcinoma could have been associated with liver congestion resulting from the stenosis. After partial hepatectomy, inferior vena cava-to-superior vena cava bypass was performed without cardiopulmonary bypass. The patient's postoperative course was uneventful, liver enzyme levels decreased to normal limits, and distant recurrence of hepatocellular carcinoma has not been observed.
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