Extra-Pericardial Inferior Vena Cava Nabil Saouti, MD PhD, and Bart P. van Putte, MD PhD Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
uring a totally thoracoscopic maze operation for paroxysmal atrial ﬁbrillation, we noticed a partially extra-pericardial inferior vena cava. In Figure 1 (left) the extra-pericardial inferior vene cava (dashed black arrow), right atrium (solid black arrow), phrenic nerve (white
Address correspondence to Dr Saouti, Department of Cardio-Thoracic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, The Netherlands; email: [email protected]
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
arrow), diaphragm (black star) and collapsed lung (white star) can be observed. On the right, the pericardium is opened with stay sutures showing the extra-pericardial inferior vena cava in relation to intra-pericardial inferior vena cava and right atrium. The prevalence of a (partially) extra-pericardial inferior vena cava is unknown, but recognizing this anatomic variation can help to prevent damaging this vessel during thoracic surgery, especially during procedures requiring opening of the pericardium toward the diaphragm.
Ann Thorac Surg 2016;102:e571 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2016.05.103