Transcatheter Treatment of Patent Foramen Ovale Combined with Abnormal Drainage of Left Superior Vena Cava to Left Upper Pulmonary Vein
A 37-year-old female patient with chief complaint of left arm weakness (duration less than 1 minute) and left-sided lip twitching was diagnosed with PFO under evaluation at Myongji Hospital. Laboratory test results showed normal value of erythrocyte sedimentation rate, C-reactive protein, no abnormality of coagulopathy, and no suspicious sign of vasculitis. While continuation of warfarin treatment and medication in regards of rhematoid arthritis diagnosed in 2007, she was referred to Pediatrics Cardiology for PFO closure. Brain magnetic resonance imaging showed signs of stroke and transcatheter closure of PFO was scheduled. Contrast echocardiography performed via the left upper extremity prior to the procedure showed sequential filling of the bubble in the LA followed by left ventricle and then through the PFO to the right atrium (). For further evaluation, heart computed tomography (CT) was performed and an abnormal connection of LSVC to LSPV which drained into LA was diagnosed ().\nUnder local anesthesia, we first evaluated the patient's hemodynamic data to confirm any presence of pulmonary hypertension and patency of coronary artery which showed normal findings. Through venous approach via right femoral vein, 7 French guiding catheter passed right atrium and innominate vein approaching to LSVC. The proximal and distal part of the LSVC were measured 9.8 and 9.6 mm, respectively by angiography (). The abnormal connection between LSVC and LSPV was closed using the Amplatzer® Vascular Plug II (diameter = 12 mm; St. Jude Medical, St. Paul, MN, USA) (). After checked up size of PFO by sizing balloon, transcatheter PFO closure with Amplatzer® PFO occluder (diameter = 25 mm; St. Jude Medical, St. Paul, MN, USA) was also performed (). Follow-up echocardiogram showed complete occlusion of flow through the LSVC and PFO.