Author`s Reply.

To the Editor,

We would like to thank the authors for their valuable comments on our case report study (1). Secundum atrial septal defect in patients with interrupted inferior vena cava (IVC) and azygos continuation is a very rare condition. The patient with azygos continuation of the IVC is usually asymptomatic and it is detected incidentally (2, 3). These anomalies are usually detected during computed tomography (CT) angiography taken for other reasons. Also, contrast should be given from the lower and upper extremities for a clear evaluation of the venous variations. CT angiography is not a routine in the preoperative evaluation of secundum atrial septal defect (ASD). Routine CT angiography is not cost-effective for a very rare condition and there are risks such as giving contrast to patients.

It may be possible to verify if cardiac catheterization is performed for atrial septal defect closure assessment. However, cardiac catheterization is not routine in the preoperative evaluation of ASD. Cardiac catheterization is required to determine PVR in patients with high PAB on echocardiography.

It is important to perform transesophageal echocardiography in patients, as part of the detailed assessment for the percutaneous closure of the ASD (4). Transesophageal echocardiography (TEE) provides adequate evaluation of the rims and size of the defect. In a patient with azygos continuation of the IVC, the hepatic veins are directly connected with the right atrium, and they can be considered as the IVC in TEE.

Consequently, as in the examples in the literature, azygos continuation of the IVC may not be detected during the preoperative evaluation, since routine CT angiography and cardiac catheterization were not performed (5). It is useful to keep in mind the techniques that should be applied when such a situation is encountered during the operation.