A novel technique for percutaneous closure of an atrial septal defect in a patient with interrupted inferior vena cava using a “modified” short sheath from an internal jugular vein approach

Figure 1: The pointed end of delivery cable was quite far cephalad from delivery sheath just after the release of the atrial septal defect occluder. (A and B) The cephalad ends of delivery sheath and delivery cable respectively This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. How to cite this article: Barik R. Delivery cable induced cardiac tamponade during transcatheter closure of atrial septal defect: A preventable complication. There are no conflicts of interest. surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. Rosti L, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. Sir, We report a novel technique for transjugular device closure of a secundum atrial septal defect (ASD) in a 4-year-old, 20 kg child with an interrupted inferior vena cava (IVC) by using a " modified " short sheath. Transesophageal echo confirmed a secundum ASD with a diameter of 16 mm. Securing the wire position in a pulmonary vein was unable to be achieved after brief attempts. We decided to use a " modified " short sheath for device delivery. was bent into a C-shape/half-moon shape and placed under cold saline to fixate the curve [Figure 1]. This sheath was placed in the right internal jugular vein, and the wire and dilator were removed. The sheath was manipulated so that its distal end was placed just across the ASD into the left atrium [Figure 2a and b]. A 20 mm Amplatzer septal occluder (St. was deployed with an excellent result [Figure 3a and b]. Transhepatic, [1] transjugular, [2] and femoral [3] approaches have been reported to close a secundum ASD with an interrupted IVC and azygous continuation. During percutaneous secundum ASD closure in patients with an interrupted IVC, it is sometimes difficult to exchange a wire in a pulmonary vein for a stiff wire, from an internal jugular or femoral venous approach. While we certainly could have placed a wire in a pulmonary vein and performed balloon sizing and ASD closure, we chose to use our " modified " short sheath technique to enable a quicker procedure. We overcame these challenges by making a " …