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(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@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 . . . [Full Text of this Article]

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