From Cyanosis to Extensive Systemic-to-Pulmonary Collaterals Formation: A Case With an Iatrogenic Connection of the
Akram Nakhaee1, Roya Sattarzadeh Badkoubeh1, Mehrzad Rahmanian2
1Cardiology Department, School of Medicine Imam Khomeini Hospital Complex, Tehran University of Medical Sciences Tehran Iran.
Insights
This case study highlights a rare complication following atrial septal defect (ASD) repair, where an iatrogenic inferior vena cava (IVC) to left atrium (LA) diversion was discovered in a 50-year-old male. Multimodality imaging was crucial for accurate diagnosis and reevaluation of prior misdiagnoses.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Medical Imaging
Background:
- Atrial septal defect (ASD) is a common congenital heart defect.
- Surgical or interventional repair is typically effective.
- Complications, though rare, can arise, necessitating thorough diagnostic evaluation.
Purpose of the Study:
- To describe a unique case of iatrogenic inferior vena cava (IVC) to left atrium (LA) diversion after ASD repair.
- To emphasize the importance of multimodality imaging in diagnosing complex cardiac conditions.
- To illustrate the potential pitfalls of initial misdiagnosis in congenital heart disease management.
Main Methods:
- Case report of a 50-year-old male with a history of ASD repair.
- Coronary computed tomography angiography (CTA) to identify systemic-to-pulmonary collaterals (SPCs) and anomalous IVC pathway.
- Transesophageal echocardiography with contrast study to confirm the IVC-LA connection.
Main Results:
- The patient presented with dyspnea, cyanosis, and hypoxemia.
- Coronary CTA revealed SPCs and an iatrogenic IVC to LA diversion.
- Transesophageal echocardiography confirmed the aberrant IVC pathway to the LA, challenging the initial Eisenmenger syndrome diagnosis.
Conclusions:
- Iatrogenic IVC-LA diversion is a rare but significant complication post-ASD repair.
- Multimodality imaging is essential for accurate diagnosis and management of complex congenital heart disease.
- Reevaluation of initial diagnostic impressions is critical, especially when clinical presentation is atypical.
Abstract:
Atrial septal defect (ASD) is a prevalent congenital heart abnormality that can be effectively repaired through either surgical or interventional procedures. We decide to describe a 50-year-old male with a history of dyspnea, cyanosis, and hypoxemia. A remarkable past medical history is that he underwent surgical correction of an ASD at the age of 6. Because of an initial misdiagnosis of Eisenmenger syndrome, he recently received palliative therapy, including therapeutic phlebotomy. Subsequent coronary computed tomography angiography (CTA) revealed systemic-to-pulmonary collaterals (SPCs) and an iatrogenic diversion of the inferior vena cava (IVC) to the left atrium (LA). A contrast study in transesophageal echocardiography confirmed the IVC's aberrant pathway to the LA. The diagnostic pathway and rationale behind these findings underscore the significance of multimodality imaging and reevaluation of the initial diagnostic impression.
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