Anaesthetist Preparedness for Transhepatic Approach to Ostium Secundum Atrial Septal Defect Device Closure: A Case Report.

Abstract: Routes for transcatheter closure of ostium secundum atrial septal defect (OS ASD) by device implantation include hepatic vein & jugular vein besides standard transfemoral approach. We report the case of a female child with OS ASD, who presented with an anomalous systemic venous drainage. Only the hepatic vein was draining directly to RA hence the only option left was transhepatic. Multidisciplinary consensus was taken and the procedure proceeded under general anaesthesia. To avoid cathlab misadventures, tracing systemic venous drainage besides pulmonary venous drainage in a case of OS ASD is important. The anaesthetist should be aware of the transhepatic approach and possible complications which may arise. Preparedness for the complications and invasive monitoring ensures success for this challenging procedure.