Iatrogenic Hepatocellular Adenoma in Relation to an Unusual Complication of Cardiac Surgery

BACKGROUND: Inferior vena cava (IVC) obstruction is a rare but serious complication after atrial septal defect (ASD) repair. CASE SUMMARY: A 50-year-old woman with prior ASD closure presented for liver transplant evaluation due to cirrhosis and a suspected hepatocellular adenoma. Examination revealed congestive hepatopathy and dyspnea (NYHA II). Imaging identified IVC obstruction from Eustachian valve entrapment and thrombus at the cavoatrial junction. She underwent successful IVC recanalization and thrombectomy, with resolution of symptoms, prompting suspension of transplant listing. DISCUSSION: IVC obstruction after ASD repair is exceedingly rare but can mimic liver disease and precipitate Budd-Chiari syndrome. Unlike previously reported cases, our patient uniquely demonstrated the coexistence of cirrhosis and an HNF1A-inactivated hepatocellular adenoma, a combination not described before in this setting. This case underscores the need to consider cardiac causes in unexplained hepatopathy, especially post-ASD repair. TAKE-HOME MESSAGES: IVC obstruction should be suspected in post-ASD repair patients with hepatopathy. Early recognition allows curative intervention and avoids unnecessary transplantation.