Published in:
03-12-2023 | Atrial Septal Defect | Images in Cardiovascular Intervention
Atrial septal defect closure via left subclavian vein: a novel technique using a steerable sheath
Published in: Cardiovascular Intervention and Therapeutics | Issue 2/2024
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A 25 year-old female who underwent an arterial switch operation for complete transposition of the great arteries presented to our hospital with shortness of breath. Transesophageal echocardiography (TEE) showed a residual leak after surgical closure of the atrial septal defect (ASD). Cardiac catheterization revealed a pulmonary-to-systemic blood flow ratio of 1.7, confirming obstruction of the inferior vena cava (IVC) due to neonatal catheterization (Fig. 1A and B). Compared to the right subclavian or internal jugular vein approach, the left subclavian vein (LSV) approach can maintain coaxiality with a single curve and provide backup force by the contralateral SVC wall. Furthermore, it avoids contamination of the sterile area by anesthesia and TEE equipment that occurs on the patient's head side [1]. Therefore, we decided to perform a transcatheter ASD closure via the LSV.
Fig. 1
A Fluoroscopic image and B digital subtraction angiography showing IVC occlusion. C A steerable sheath threading through a long sheath inserted into the Left subclavian vein. D Shaping of the sheath. E The sheath delivering into the left atrium. In vitro studies showed that ASO device results in cobrahead malformation F, while FSO device was able to avoid it G. H Transesophageal echocardiography image. I Fluoroscopic image showing FSO device deployment. DSA digital subtraction angiography; IVC inferior vena cava; ASO Amplatzer septal occlude; FSO Figulla Flex II septal occlude; ASD atrial septal defect; SVC superior vena cava; Ao aorta; TV tricuspid valve
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