Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series

Author:

Abudan Anas1ORCID,Kidd Brent2ORCID,Hild Peter2ORCID,Gupta Bhanu3

Affiliation:

1. Department of Medicine, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA

2. Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA

3. Department of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA

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.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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