Why the study?
LAAC is traditionally performed via the femoral vein and IVC, but anatomical abnormalities such as interrupted IVC, situs inversus totalis, or dextrocardia can make access and implantation challenging.
Demonstrates the feasibility of a transhepatic approach for left atrial appendage closure in a patient with situs inversus totalis and interrupted inferior vena cava.
May offer alternative access in rare venous anomalies; hypothesis-generating case report requiring prospective validation before practice change.
Left atrial appendage closure (LAAC) has emerged as a viable alternative to oral anticoagulation for prevention of stroke, and its use is increasing.1 The procedure is traditionally performed via accessing the common femoral vein and entering the right atrium through the inferior vena cava (IVC). However, anatomical abnormalities such as interrupted IVC, situs inversus totalis (SIT), or dextrocardia can make access and implantation challenging. Interruption of the IVC is a rare condition with an incidence of approximately 1:5000 based on prenatal ultrasound screening and present in 0.1% of adults referred for abdominal computed tomography.
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Tandon et al. (2020) studied this question.
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