PMC7192144_01
Abdominal CT with contrast showing the abdominal aorta with renal artery branches. Renal veins are also seen, but the IVC is absent.
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A 60-year-old male with a congenital absence of the inferior vena cava (IVC) (Figures 1 and 2) presented with symptomatic, persistent AF (Figure 3), with resulting cardiomyopathy related to his tachyarrhythmia.
Chest CT with contrast demonstrating the SVC feeding into the right atrium. The descending aorta is seen, but the IVC is not visualized.
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A 60-year-old male with a congenital absence of the inferior vena cava (IVC) (Figures 1 and 2) presented with symptomatic, persistent AF (Figure 3), with resulting cardiomyopathy related to his tachyarrhythmia.
Electrocardiogram displaying an absence of P-waves and irregular R-R intervals indicating the presence of AF.
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A 60-year-old male with a congenital absence of the inferior vena cava (IVC) (Figures 1 and 2) presented with symptomatic, persistent AF (Figure 3), with resulting cardiomyopathy related to his tachyarrhythmia.
Left atrial endocardial activation map during coronary sinus pacing after the Cox maze IV procedure illustrating complete isolation of the left atrial posterior wall and pulmonary vein pedicle with voltage readings of less than 0.01 mV (gray region). From left to right: anteroposterior and posteroanterior views.
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An endocardial three-dimensional (3D) map of the left atrium was constructed using the Rhythmia HDx  hardware and software (Boston Scientific, Natick, MA, USA) and with fusion of computed tomography (CT) images (Figure 4).
Activation map during coronary sinus pacing after the Cox maze IV procedure illustrating the epicardial left atrium with minimal activity (gray depicts less than 0.01 mV). From left to right: anteroposterior and posteroanterior views.
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We created an epicardial electroanatomical map using the same mapping system by manipulating the catheter around the epicardial surface (Figure 5).
Left atrial bipolar voltage map after the Cox maze IV procedure demonstrating no significant activity in the left atrial posterior wall (0.01-20 mV; gray depicts less than 0.01 mV). From left to right: epicardial posteroanterior and endocardial posteroanterior views.
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This demonstration of the endocardial and epicardial completeness of the Cox maze IV procedure indicated no necessity to add further RF lesions to complete the operation (Figure 6).