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

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.