# From Cyanosis to Extensive Systemic‐to‐Pulmonary Collaterals Formation: A Case With an Iatrogenic Connection of the Inferior Vena Cava to the Left Atrium

## TL;DR

A 50-year-old man with a history of heart surgery shows unusual blood vessel connections due to a past misdiagnosis and treatment.

## Contribution

Highlights the importance of reevaluating diagnoses and using multimodal imaging in complex heart cases.

## Key findings

- Patient had iatrogenic connection between the inferior vena cava and left atrium.
- Systemic-to-pulmonary collaterals were identified via coronary CTA.
- Misdiagnosis of Eisenmenger syndrome led to inappropriate palliative therapy.

## Abstract

Atrial septal defect (ASD) is a prevalent congenital heart abnormality that can be effectively repaired through either surgical or interventional procedures. We decide to describe a 50‐year‐old male with a history of dyspnea, cyanosis, and hypoxemia. A remarkable past medical history is that he underwent surgical correction of an ASD at the age of 6. Because of an initial misdiagnosis of Eisenmenger syndrome, he recently received palliative therapy, including therapeutic phlebotomy. Subsequent coronary computed tomography angiography (CTA) revealed systemic‐to‐pulmonary collaterals (SPCs) and an iatrogenic diversion of the inferior vena cava (IVC) to the left atrium (LA). A contrast study in transesophageal echocardiography confirmed the IVC's aberrant pathway to the LA. The diagnostic pathway and rationale behind these findings underscore the significance of multimodality imaging and reevaluation of the initial diagnostic impression.