PMC8447089_01
From left to right, mid-esophageal and bicaval views of transesophageal echocardiogram
revealing the ASD (arrows), mid-esophageal view after deployment of the ASO device
(arrows) without residual shunting, and a 3D view (far right image) of the ASO device
(arrow) occupying the ASD defect.. Abbreviations: ASD, atrial septal defect; ASO, Amplatzer septal occlude.
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A subsequent transesophageal echocardiogram (TEE) confirmed a secundum ASD measuring 2.2 by 1.8 cm (Figure 1). A computed tomography chest pulmonary embolism (CT-PE) was obtained to evaluate for the presence of PE due to her elevated RVSP and enlarged RV.
From left to right, venogram of the initial transfemoral approach revealing the
anomalous course of the inferior vena cava and its connection with the right atrium from
the left side indicated by the trajectory of the guidewire (arrows) which in turn
courses through the atrial septal defect into the right upper pulmonary vein.
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A subsequent venogram (Figure 2) at the level of the femoral vein was notable for a left-sided IVC that reconnected with the RA at the hepatic level.
From left to right, venogram of the subsequent transhepatic approach showing the
guidewire access into the inferior vena cava from the hepatic vein (arrows) and eventual
deployment (third image) of the Amplatzer septal occluder device (arrow) within the
atrial septal defect.
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The right hepatic vein (Figures 3 and 4) was accessed using a 21-gauge needle.
Pictorial depiction of the transhepatic access demonstrating a left-sided liver and
IVC, a longer right common iliac vein, and the guidewire access to the IVC via the
hepatic vein.. Abbreviations: ASD, atrial septal defect; ASO, Amplatzer septal occlude; IVC, inferior
vena cava.
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The right hepatic vein (Figures 3 and 4) was accessed using a 21-gauge needle.