# Femoral Vein Cannulation to the Left-Sided Inferior Vena Cava in Minimally Invasive Cardiac Surgery: A Case Report

## TL;DR

This case report shows that femoral vein cannulation is possible in patients with a rare left-sided inferior vena cava during minimally invasive heart surgery.

## Contribution

Demonstrates a successful technique for venous cannulation in the presence of a left-sided IVC using X-ray fluoroscopy.

## Key findings

- Femoral vein cannulation was successfully performed through a left-sided IVC during minimally invasive cardiac surgery.
- X-ray fluoroscopy helped avoid venous injury and improve the reproducibility of the procedure.
- Preoperative imaging is crucial for identifying IVC anomalies to prevent complications.

## Abstract

A left-sided inferior vena cava (left-sided IVC) is a congenital venous anomaly in which the IVC runs along the left side of the abdominal aorta. We successfully inserted a venous cannula from the right femoral vein (FV) to the right atrium through a left-sided IVC. We established cardiopulmonary bypass during minimally invasive cardiac surgery (MICS).

We present a case of a 75-year-old man with controlled diabetes mellitus who underwent aortic valve replacement via MICS (MICS-AVR) with a 23-mm Epic porcine valve. He had severe aortic regurgitation with a three-month history of exertional dyspnea. MICS-AVR was planned as he wished to return to physical labor early. However, a left-sided IVC was found on the preoperative computed tomography. It exhibited a peculiar flexure, raising concerns about whether the venous cannula would pass through it. However, FV cannulation was successfully performed under X-ray fluoroscopy.

This case demonstrates the feasibility of FV cannulation even in patients with left-sided IVC, with X-ray fluoroscopy proving useful in avoiding venous injuries and enhancing the reproducibility of the procedure. It also highlights the importance of preoperative assessment for IVC anomalies to prevent perioperative complications and optimize the surgical plan.