Show Summary Details
Page of

An interrupted inferior vena cava 

An interrupted inferior vena cava
Chapter:
An interrupted inferior vena cava
Author(s):

Hein Heidbuchel

, Mattias Duytschaever

, and Haran Burri

DOI:
10.1093/med/9780198766377.003.0044
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

Subscriber: null; date: 08 December 2021

Introduction to the case

A 72-year-old woman with severe dilated cardiomyopathy and cardiac resynchronization therapy defibrillator (CRT-D) implantation had persistent atrial fibrillation with rapid ventricular response. She was scheduled to undergo AV nodal ablation. The ablation catheter was advanced to the level of the cardiac silhouette (Figure 44.1a) but was impossible to advance into the RV and no near-field electrograms were recorded (Figure 44.1b).

Figure 44.1 Procedural findings. (a) The ablation catheter advanced to the level of the cardiac silhouette. (b) Electrogram of the ablation catheter

Figure 44.1
Procedural findings. (a) The ablation catheter advanced to the level of the cardiac silhouette. (b) Electrogram of the ablation catheter

Question

Where is the ablation catheter positioned?

  1. A Right atrium with atrial standstill

  2. B Descending aorta

  3. C Azygos vein

  4. D Thoracic vein

  5. E Mediastinal space

Answer

C Azygos vein

Explanation

Azygos continuation of an interrupted inferior vena cava

The catheter is too posterior to be in the right atrium (LL view). The descending aorta is posterior, but the catheter would be more to the patient’s left in the PA view. This patient has azygos continuation of an interrupted inferior vena cava. This anomaly occurs in 0.8% of the population requiring electrophysiological procedures1 and is due to agenesis of the hepatic tract of the inferior vena cava. The caudal segment of the inferior vena cava reaches the azygos system via a persistent right supracardinal vein.2 The anomaly has no functional consequences, other than rendering some ablation procedures difficult via an inferior access (e.g. in case a trans-septal puncture is required). Procedures such as cavotricuspid isthmus ablation or slow pathway modification are, however, relatively easily performed, as was ablation of the AV node in our patient (the position of the catheter advanced into the heart is shown in Figure 44.2).

References

1. Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002; 12: 2040–55.Find this resource:

2. Perez-Silva A, Merino JL, Peinado R, Lopez-Sendon J. Atrial flutter ablation through the azygous continuation in a patient with inferior vena cava interruption. Europace 2011; 13: 442–3.Find this resource: