Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series. Issue 2 (20th February 2021)

• Record Type: Journal Article
• Authors: Abudan, Anas; Kidd, Brent; Hild, Peter; Gupta, Bhanu
• Editors: Holy, Matteo Cameli/Erik; Abdullah, Abdullah Sayied; Abela, Mark; Simovic, Stefan; Shahil Mehta, Vishal
• Is Part Of: European heart journal. Volume 5:Issue 2(2021)
• Publication Date: 2021-02-20
• Subjects: Heart transplantation -- Transoesophageal echocardiography -- Obstruction -- inferior vena cava -- Bicaval technique -- Case series; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab046
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. Case summary: Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. Discussion: Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.