This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Linka, A. Z. Articles by Jenni, R. Search for Related Content PubMed PubMed Citation Articles by Linka, A. Z. Articles by Jenni, R. Related Collections Catheter-based coronary and valvular interventions: other Echocardiography CV surgery: valvular disease

(Circulation. 2001;103:161.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Migration of Intrahepatic Portosystemic Stent into Right Ventricle

An Unusual Cause of Tricuspid Regurgitation

Andre Z. Linka, MD; Rolf Jenni, MD, MSEE

From the Cardiovascular Center, Echocardiography Laboratory, University Hospital, Zurich, Switzerland.

Correspondence to Andre Linka, MD, Cardiovascular Center, Echocardiography Laboratory, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland. E-mail karlinka{at}usz.unizh.ch

A 65-year-old woman with terminal liver disease and portal hypertension secondary to alcohol-induced cirrhosis underwent an elective transjugular intrahepatic portosystemic shunt procedure. A self-expanding, 100x80-mm Nitinol (Jomed AG) stent was implanted and extended cranially using an additional 40x12-mm Wallstent (Boston Scientific). During the same admission, she was evaluated and accepted for liver transplantation, which was performed 4 days later when an organ was available. In the explanted liver, one patent intraparenchymal stent was described by the pathologist. Three weeks after surgery, she was referred to a rehabilitation facility. The new organ showed good function, but she had a recurrence of ascites that was managed medically, and she returned home 6 weeks after liver transplantation. In the seventh postoperative week, however, the amount of ascites increased, which necessitated the drainage of several liters of peritoneal fluid. About 8 weeks after surgery,she became increasingly dyspneic. A chest radiograph at that time showed no evidence of pleural effusion or consolidation but, surprisingly, it did reveal a radio-opaque stent-like structure projected over the right ventricle. Doppler echocardiography (Figure 1 and 2) was performed, and it revealed a stent in the right ventricle caught within the subvalvular tricuspid apparatus, leading to severe tricuspid regurgitation.

View larger version (84K): [in this window] [in a new window]   Figure 1. A, Apical 4-chamber view by transthoracic echocardiography. Right ventricle (RV) and right atrium (RA) are enlarged. Stent (arrow) is caught horizontally within subvalvular tricuspid apparatus. B, View perpendicular to that in A. LV indicates left ventricle; LA, left atrium.

View larger version (48K): [in this window] [in a new window]   Figure 2. Apical 4-chamber color Doppler recording (same view as that shown in Figure 1A) demonstrating a broad and turbulent regurgitant jet in systole extending from tricuspid valve (large arrow) to superior wall of right atrium (RA), indicating severe tricuspid regurgitation. Note perfusion (blue color) of stent (small double arrow). RV indicates right ventricle.

The stent was removed at surgery, and the tricuspid valve was reconstructed because the stent had perforated the septal leaflet. She had an uneventful postoperative recovery, without recurrence of ascites.

It was concluded that the second Wallstent had dislodged during the perioperative period, most likely during the transplantation itself. In retrospect, the stent was seen on the first postoperative chest radiograph performed on the day of surgery.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				R. A. Byrne, D. Mylotte, P. Nolan, and P. Nash Migration of inferior vena cava stent into right ventricle: two- and three-dimensional echocardiographic imaging Eur J Echocardiogr, March 1, 2009; 10(2): 370 - 371. [Abstract] [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Linka, A. Z. Articles by Jenni, R. Search for Related Content PubMed PubMed Citation Articles by Linka, A. Z. Articles by Jenni, R. Related Collections Catheter-based coronary and valvular interventions: other Echocardiography CV surgery: valvular disease