PMC2921523_01
Left femoral venogram showing blocked external iliac vein. The vein that reforms distally passes along the right border of vertebra suggesting blocked lower end of inferior vena cava also
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A left femoral venogram showed external iliac vein occlusion and evidence of occlusion of lower end of IVC [Figure 1].
Short sheath through IJV, the tip of which is restraining the Rashkind balloon at SVC-RA junction
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Care was taken to keep the tip of the sheath beyond the superior vena cava - right atrial junction, so that injury to the SA node could be avoided during the 'pull' of the catheter [Figure 2].
Rashkind balloon in LA, which was passed through the PFO after pre-shaping it with pacemaker lead stylet
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Since the Rashkind balloon could not be negotiated to LA by standard maneuver through the FO ASD, the balloon was pre-shaped to 90  angulation by inserting a pacemaker lead stylet [Figure 3].
NuMED atrioseptostomy catheter in the left atrium passed over a 0.014" coronary wire, which is parked in left ventricle
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Over the wire a NuMED Z-5  SPT 002-9.5 mm atrioseptostomy catheter (NuMED, Inc.) was introduced and BAS was performed [Figure 4].