Author + information
- Received November 13, 2017
- Revision received January 10, 2018
- Accepted January 14, 2018
- Published online April 16, 2018.
- Masao Imai, MD∗ (, )
- Masaharu Yoshida, MD,
- Toshiaki Toyota, MD,
- Hiroki Shiomi, MD,
- Satoshi Shizuta, MD,
- Naritatsu Saito, MD and
- Takeshi Kimura, MD
- ↵∗Address for correspondence:
Dr. Masao Imai, Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
A 31-year-old male patient with a history of situs inversus, dextrocardia, and interrupted inferior vena cava (IVC) with azygous continuation referred to our hospital (Figure 1A). Transesophageal echocardiography revealed a 9 mm × 16 mm atrial septal defect (ASD) with continuous left-to-right shunting with small aortic rim and the defect surface of the septum primum is different from that of the septum secundum, which indicates malalignment (Figure 1B). To perform catheter intervention for a patient with such a complicated anatomy, pre-operative simulation using a 3-dimensional (3D) organ model (Cross Effect Inc., Kyoto, Japan) was constructed by computed tomography (CT) imaging (Figure 1C). A 21-mm Occlutech ASD Occluder Figulla Flex2 (Occlutech GmbH, Jena, Germany) was selected in accordance with the defect size as seen on pre-procedural transesophageal echocardiography and CT.
To perform this catheter intervention, we used a 12-F FlexCath Advance Steerable Sheath for cryoablation (Medtronic, Minneapolis, Minnesota) via a left jugular venous approach. Subsequently, an in vitro trial occlusion was performed successfully in the elastic rubber model for pre-operative evaluation (Figures 1D and 1E). In the real clinical procedure, the device was deployed successfully. Post-operative CT showed perfect positioning of the device (Figure 1F, Online Video 1).
To the best of our knowledge, this is the first application of 3D organ model with transcatheter closure of an ASD with IVC interruption and situs inversus and dextrocardia. Congenital absence of the intrahepatic segment of the IVC is a congenital anomaly found in 0.1% to 0.6% of the general population and in approximately 1% to 3% of patients with congenital heart disease (1,2). This patient has situs inversus, and the position of the defect is located in the anteroposterior direction. Although successful transcatheter closure has been reported in ASD with interrupted IVC by using an 8.5-F steerable sheath for ablation via the transjugular approach (3), it is still difficult to predict successful closure. A personalized heart model can be produced using 3D printing, which assists with the pre-operative evaluation of ASD (4). Pre-operative simulation using a 3D organ model can predict successful catheter treatment and decrease related complications.
Dr. Kimura has served as an advisory board member for Cordis Cardiology, Abbott Vascular, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 13, 2017.
- Revision received January 10, 2018.
- Accepted January 14, 2018.
- 2018 American College of Cardiology Foundation
- Takaya Y.,
- Akagi T.,
- Ito H.
- Chaowu Y.,
- Hua L.,
- Xin S.