A Rare Case of Stenosis at the Inferior Vena Cava to Right Atrium Anastomosis After Bicaval Orthotopic Heart Transplantation

Seminars in Cardiothoracic and Vascular Anesthesia
Benjamin AbramsTamas Seres

Abstract

Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of th...Continue Reading

References

May 16, 2000·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·R A BleasdaleN R Banner
Jan 28, 2005·Journal of Cardiac Surgery·Jeffrey A Morgan, Niloo M Edwards
Sep 22, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Eric JacobsohnCharl J De Wet
Nov 3, 2007·The Journal of Thoracic and Cardiovascular Surgery·Maike SchnoorHans H Sievers
Dec 3, 2014·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·Silvio H LitovskyF Bennet Pearce

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Citations

Nov 7, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·J Mauricio Del RioMiklos D Kertai
Jul 11, 2020·World Journal for Pediatric & Congenital Heart Surgery·Akintayo I AdesokanDavid S Crossland
Aug 14, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·Jiapeng HuangNathaen Weitzel
Mar 20, 2021·European Heart Journal. Case Reports·Anas AbudanBhanu Gupta
Dec 24, 2021·Current Opinion in Organ Transplantation·S Shiva PatlollaShelley Hall

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