PMC9931606_01
A small caliber tract from inferior vena cava (IVC) adjacent to left atrium (LA)
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Contrast angiography was done in anteroposterior (AP) and left anterior oblique views which showed that the contrast was going into the LA straightly through the IVC via a small caliber tract from IVC adjacent to the LA without any fenestration or defect in the ASD patch, because the contrast did not fill the RA (Figure 1).
Contrast injection from upper extremity without opacification of left atrium (LA)
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At the first echocardiogram, we did not see the significant pathology, but after the catheterization, transesophageal echocardiography (TEE) was done and showed that IVC was deviated toward LA, probably by eustachian valve and pericardial patch; thus, contrast injection from lower extremity showed opacification of LA (Figure 2).
Small defect at inferior part of interatrial septum with continuous turbulent flow (max pressure gradient: 9 mmHg)
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Computed tomography (CT) angiography showing the presence of inferior vena cava (IVC) with interrupted appearance in right atrium (RA) confluence and a suspicious small caliber tract to left atrium (LA)
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Coronary computed tomography (CT) angiography, done based on congenital protocols, showed normal epicardial coronary arteries and presence of IVC with interrupted appearance in RA confluence, and a suspicious small caliber tract to LA in most cephalad part of IVC adjacent to interrupted part was seen (Figure 4).