Severe Tricuspid Stenosis during Percutaneous Occlusion of Perimembranous Ventricular Septal Defect with the New Amplatzer Device

Abstract

Device release was achieved by manipulation on the tricuspid apparatus.

Tricuspid stenosis: A rare and potential complication of ventricular septal occluder device

“…Even though the success rate of complete closure using the ASOD is high (>90%),[ 10 ] it is not without risks. In the immediate postdeployment period, device malposition and embolization often occur while in the long-term conduction block, injury to the valvular structure causing TR and/or AR, left ventricular outflow tract obstruction and hemolysis may occur.…”

“…[ 6 ] reported a case of TS in the study of a large group of VSD device closure patients that was relieved by balloon dilatation. Christiani et al .,[ 10 ] found TS immediately following postdevice deployment due to entrapment of the right ventricular disc in the chordae of the anterior tricuspid leaflet which was relieved by chance when they tried to retrieve the device. They proposed that right coronary Judkin catheter that was passed through the defect from the arterial side would have passed through the chordae of the anterior leaflet of tricuspid valve given its proximity to the VSD, thus causing the entrapment of the right ventricular disc into the chordal structure during the device deployment.…”

“…The device malalignment may be fatal at times as in the Christiani et al . [ 10 ] report, TS caused pressure elevation in the right atrium leading to shunting of blood through patent foramen ovale (PFO) into the left atrium causing desaturation and relief of right atrial pressure, however, in the absence of PFO same incident may have been fatal before detection of the cause.…”

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach

“…4a). The another problem would may be the interaction of the eccentric disc of the device with the tricuspid valve septal leaflet (8, 20, 21). Indeed this condition some degree was more likely because of longer inferior left ventricular wings of the eccentric device and the more right position of the device caused by rightward shift of the aneurysm wall.…”

Fechamento percutâneo da comunicação interventricular muscular congênita

“…Apesar de ser relativamente simples, a técnica de implante percutâneo é algo trabalhosa e, a nosso ver, é recomendável que o procedimento seja realizado ou supervisionado por intervencionistas pediátricos com experiência em oclusão de outros defeitos cardíacos e que estejam familiarizados com dispositivos intracardíacos e com imagens ecocardiográficas. Mais especificamente, durante a formação da alça arteriovenosa, é necessário estar seguro sobre o funcionamento adequado da valva tricúspide 30 . No caso de mau funcionamento dessa valva, em alguns casos pode ser necessário cruzar novamente o defeito para se estabelecer outra vez a alça arteriovenosa com o fio-guia.…”