Veno-arterial rail and over the wire technique for atrial septal defect closure in a patient with interrupted inferior venae cava.

Transcatheter closure of secundum atrial septal defect (ASD II) is considered the treatment of choice when anatomically suitable and clinically indicated. This is routinely done through the inferior vena cava via a femoral venous approach; however, certain anatomical anomalies, such as congenital interruption of inferior vena cava with azygos continuation, render the delivery of the device either difficult or not possible. When this anomaly is also associated with dextrocardia, the technical challenge increases further due to the unusual orientation of the interatrial septum. We describe a case of transcatheter closure of ASD II via left internal jugular vein approach with some modification of the standard technique. We used a combination of veno-arterial rail by parking the super-stiff wire in the descending aorta instead of the usual method of parking it in the pulmonary vein for better support, and over the wire technique during device deployment to maintain the delivery sheath position during device deployment. Changing the vascular access with the modification of the standard technique of closure was the key to success in this patient. < Transcatheter atrial septal defect closure in patients with interrupted inferior vena cava can be successfully performed via trans jugular approach using a combination of veno-arterial rail and over the wire technique as a technical modification to the standard procedure's steps inorder to increase the support while crossing with the delivery sheath and maintain its position during deployment of the device.>.