Anaesthetist Preparedness for Transhepatic Approach to Ostium Secundum Atrial Septal Defect Device Closure: A Case...

Area of Science:

• Interventional Cardiology
• Pediatric Cardiac Surgery
• Vascular Anatomy

Background:

• Transcatheter device closure is a standard treatment for ostium secundum atrial septal defects (OS ASD).
• Anomalous systemic venous drainage can complicate standard closure approaches.
• The hepatic vein and jugular vein are alternative access routes for device implantation.

Purpose of the Study:

• To report a transhepatic approach for OS ASD closure in a pediatric patient with anomalous systemic venous drainage.
• To highlight the importance of pre-procedural venous anatomy assessment in complex ASD cases.
• To emphasize the need for multidisciplinary collaboration and preparedness for challenging interventional procedures.

Main Methods:

• A pediatric patient with OS ASD and anomalous systemic venous drainage was identified.
• A transhepatic venous access route was chosen due to the unique anatomy (only hepatic vein draining to the right atrium).
• The procedure was performed under general anesthesia with multidisciplinary consensus and invasive monitoring.

Main Results:

• Successful transcatheter closure of the OS ASD was achieved via the transhepatic route.
• The procedure required careful planning and execution due to the patient's complex venous anatomy.
• No immediate complications were reported during or after the intervention.

Conclusions:

• The transhepatic approach is a feasible alternative for OS ASD closure in select pediatric cases with anomalous venous drainage.
• Thorough pre-procedural evaluation of systemic and pulmonary venous anatomy is crucial for planning complex transcatheter interventions.
• Anesthesiologist awareness and preparedness for potential complications are vital for successful outcomes in challenging transhepatic procedures.