{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:58:29Z","timestamp":1788483509444,"version":"build-2803163510"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Iatrogenic diversion of inferior vena cava (IVC) to the left atrium (LA) after atrial septal defect repair (ASD) is an unusual complication. It rarely occurred nowadays due to trans-oesophageal echocardiography (TEE) check during surgery, but there are still few numbers of patients who survived from an old operation during childhood and reached adulthood undiagnosed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present a 27-year-old female post ASD repair in childhood with a unique presentation of recurrent abortion in adulthood besides exertional dyspnoea. A full workup of investigations was normal except for haemoglobin of 21 and oxygen saturation of 70%. TEE revealed abnormal drainage of IVC to the LA. Surgical correction was done to release the IVC opening to drain in the right atrium and the oxygen saturation reached 99% after weaning from the bypass machine. The postoperative course was uneventful, and the patient was discharged 5 days later. Two years later, she got pregnant twice and completed her pregnancies to term with well-developed infants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The diversion of the IVC may be either complete or partial. Such complications may result in intraoperative death on the table or may present as early desaturation, shortness of breath, cyanosis, and clubbing, or it may present with such symptoms in adulthood. Rarely, it may present with cerebral stroke. Our case presented with the unexpected presentation of recurrent abortion. So, even if it is rare, echocardiography should be considered as a workup for recurrent abortion in a patient with a history of congenital heart surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac348","type":"journal-article","created":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T12:47:41Z","timestamp":1660826861000},"source":"Crossref","is-referenced-by-count":3,"title":["Iatrogenic diversion of inferior vena cava to the left atrium presented as recurrent foetal loss: a case report"],"prefix":"10.1093","volume":"6","author":[{"given":"Ahmad K","family":"Darwazah","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Palestinian Medical Complex , Al-Ahli hospital St, 3838, Ramallah, West Bank , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-1143","authenticated-orcid":false,"given":"Baraa J","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Palestinian Medical Complex , Al-Ahli hospital St, 3838, Ramallah, West Bank , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moath","family":"Nairat","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Palestinian Medical Complex , Al-Ahli hospital St, 3838, Ramallah, West Bank , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa","family":"Khdour","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Palestinian Medical Complex , Al-Ahli hospital St, 3838, Ramallah, West Bank , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamad","family":"Madi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Palestinian Medical Complex , Al-Ahli hospital St, 3838, Ramallah, West Bank , Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,18]]},"reference":[{"key":"2022090612314590700_ytac348-B1","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJM199012133232401","article-title":"Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years","volume":"323","author":"Murphy","year":"1990","journal-title":"N Engl J Med"},{"key":"2022090612314590700_ytac348-B2","doi-asserted-by":"crossref","first-page":"E102","DOI":"10.1111\/j.1747-0803.2012.00685.x","article-title":"Inferior vena cava to left atrium shunt presenting with polycythemia and stroke three decades following closure of atrial septal defect","volume":"8","author":"Desai","year":"2013","journal-title":"Congenit Heart Dis"},{"key":"2022090612314590700_ytac348-B3","first-page":"221","article-title":"Iatrogenic diversion of inferior vena cava to left atrium\u2014a rare complication of surgical ASD repair","volume":"2","author":"Vikas","year":"2018","journal-title":"IHJ Cardiovasc Case Rep"},{"key":"2022090612314590700_ytac348-B4","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S0828-282X(07)70848-6","article-title":"Iatrogenic cyanosis and clubbing: 25 years of chronic hypoxia after the repair of an atrial septal defect","volume":"23","author":"Alanbaei","year":"2007","journal-title":"Can J Cardiol"},{"key":"2022090612314590700_ytac348-B5","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1136\/thx.27.6.754","article-title":"Complications following closure of atrial septal defects of the inferior vena caval type","volume":"27","author":"Ross","year":"1972","journal-title":"Thorax"},{"key":"2022090612314590700_ytac348-B6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4103\/0974-2069.93716","article-title":"Iatrogenic diversion of IVC to left atrium after surgical closure of ASD","volume":"5","author":"Jain","year":"2012","journal-title":"Ann Pediatr Cardiol"},{"key":"2022090612314590700_ytac348-B7","first-page":"88","article-title":"Iatrogenic diversion of inferior vena cava into left atrium after surgery for a rare combination of congenital heart diseases","volume":"11","author":"Sabzi","year":"2016","journal-title":"J Tehran Heart Cent"},{"key":"2022090612314590700_ytac348-B8","doi-asserted-by":"crossref","first-page":"481","DOI":"10.4103\/aca.ACA_83_17","article-title":"Inadvertent diversion of inferior vena cava to left atrium after repair of atrial septal defect\u2014early diagnosis and correction of error: role of intraoperative transesophageal echocardiography","volume":"20","author":"Choudhari","year":"2017","journal-title":"Ann Card Anaesth"},{"key":"2022090612314590700_ytac348-B9","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1213\/01.ane.0000256913.47302.c7","article-title":"The utility of transesophageal echocardiography for detecting residual shunt in a patient undergoing atrial septal defect repair","volume":"104","author":"Tempe","year":"2007","journal-title":"Anesth Analg"},{"key":"2022090612314590700_ytac348-B10","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1136\/thx.13.4.261","article-title":"The operation and management of a case after diversion of the inferior vena cava into the left atrium after the open repair of an atrial septal defect","volume":"13","author":"Bjork","year":"1958","journal-title":"Thorax"},{"key":"2022090612314590700_ytac348-B11","doi-asserted-by":"crossref","first-page":"851","DOI":"10.2214\/ajr.98.4.851","article-title":"Diversion of the inferior vena cava into the left atrium following atrial septal defect closure","volume":"98","author":"Staple","year":"1966","journal-title":"Am J Roentgenol Radium Ther Nucl Med"},{"key":"2022090612314590700_ytac348-B12","first-page":"228","article-title":"Cyanosis after closure of atrial septal defect","volume":"110","author":"Lew","year":"1969","journal-title":"Calif Med"},{"key":"2022090612314590700_ytac348-B13","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1097\/00006254-197709000-00012","article-title":"Fetal growth retardation and increased infant mortality at high altitude","volume":"32","author":"McCullough","year":"1977","journal-title":"Obstet Gynecol Surv"},{"key":"2022090612314590700_ytac348-B14","first-page":"2139","article-title":"Polycythemia vera","volume":"69","author":"Stuart","year":"2004","journal-title":"Am Fam Physician"},{"key":"2022090612314590700_ytac348-B15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3892\/etm.2021.10941","article-title":"Polycythemia vera in pregnancy represents a challenge for a multidisciplinary collaboration: a case report and literature review","volume":"23","author":"Bohiltea","year":"2022","journal-title":"Exp Ther Med"}],"container-title":["European Heart Journal - 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