Endovascular Management of Inferior Vena Cava-Right Atrial Luminal Narrowing Following Orthotopic Heart Transplantation: A Case Report.

We report a rare case of early postoperative inferior vena cava-right atrial (IVC-RA) narrowing following bicaval orthotopic heart transplantation in a 68-year-old woman. Six days after transplantation, the patient developed severe venous congestion and multi-organ dysfunction. Mechanical obstruction at the IVC-RA junction, rather than intrinsic stenosis, was diagnosed using hepatic Doppler ultrasonography and venography. Due to the high risk associated with surgical reintervention, urgent endovascular treatment was performed. A self-expanding stent was deployed using a bidirectional approach via the femoral and jugular veins to overcome anatomical distortion. The procedure immediately restored venous flow and reversed organ dysfunction. This case highlights that mechanical IVC-RA distortion can cause life-threatening obstruction, and that prompt endovascular correction can serve as a safe, minimally invasive alternative to surgery.