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 ).