Abudan Anas, Kidd Brent, Hild Peter, Gupta Bhanu
Department of Medicine, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
Eur Heart J Case Rep. 2021 Feb 20;5(2):ytab046. doi: 10.1093/ehjcr/ytab046. eCollection 2021 Feb.
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.
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.
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.
下腔静脉（IVC）梗阻是原位心脏移植（OHT）的一种罕见并发症，且仅见于双腔静脉手术技术。术后IVC吻合口梗阻的临床意义、诊断、并发症及处理尚未得到充分描述。
两名终末期心力衰竭患者接受了双腔静脉OHT。术后病程出现对液体复苏、强心/血管升压药物支持均无效的休克。经食管超声心动图（TOE）诊断为IVC-右心房（RA）吻合口梗阻，促使紧急再次手术。在两例患者中，均发现一个大的供体下腔静脉瓣限制了IVC-RA吻合口的血流。切除该瓣膜后，吻合口梗阻缓解，血流动力学及临床结局随后得到改善。
我们报道了两例双腔静脉OHT术后IVC梗阻的病例，推测此类病例较为罕见。下腔静脉梗阻是术后难治性低血压和休克的一个未被充分认识的原因。使用TOE进行快速诊断对于立即进行手术矫正及预防多器官功能衰竭至关重要。梗阻可能由位于IVC吻合口缝线处的增厚的下腔静脉瓣引起，这需要手术切除。
