Surgical Planning
In a hybrid operating room, 6 and 7 French (Fr) sheaths were advanced
percutaneously using a micropuncture technique into the right common
femoral artery and vein, respectively. A 6 Fr sheath and a 10 Fr multi
lumen venous sheath was advanced similarly into the left common femoral
artery and vein, respectively. In the event emergent bypass was needed,
a 4 Fr sheath was advanced into the left superficial femoral artery and
a 9 Fr sheath was advanced under ultrasound guidance into the right
internal jugular (RIJ) vein. The patient was then partially
anticoagulated.
Cardiac catheterization demonstrated no flow through the SVC baffle,
with venous drainage from the upper body traveling through a massively
dilated hemi-azygous vein in communication with the inferior vena cava
(IVC), which drains into the LA via the IVC baffle. The IVC baffle had
no signs of obstructive disease (Figure 1 ).