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Impingement of the Occluder on Tricuspid Valve

Zahra khajali, MD 1 ; and Marzieh Khayatzadeh, MD 1, *
1 Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran
*Corresponding author: Marzieh Khayatzadeh, MD, MD, Fellowship of Echocardiography, Echocardiography Department, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran. Tel: +98-9121894993, E-mail: marzi_khayat@yahoo.com.
Archives of Cardiovascular Imaging. 2014 February; 2(1) , DOI: 10.5812/acvi.17231
Article Type: Discussion; Received: Dec 28, 2013; Revised: Feb 2, 2014; Accepted: Feb 2, 2014; epub: Feb 19, 2014; ppub: Feb 2014

Keywords: VSD; Complication

1. Introduction


A 16 year-old-boy with history of recent transcatheter ventricular septal defect (VSD) device closure referred to the adult congenital heart disease clinic for annual follow up. He had no symptom. Transthoracic echocardiography revealed LV and RV enlargement and moderate tricuspid regurgitation. What is the diagnosis in transthorasic four-chamber and subcostal view?

Figure 1.
Transthorasic Four-chamber View

2. Answer


Transthoracic echocardiography views showing entrapped septal tricuspid leaflet in VSD occlude device as one of the transcatheter VSD device closure complication.

Figure 2.
Transthorasic Subcostal View

3. Comment


The most common adverse events after VSD device closure is conduction anomalies (15%) (1, 2). Tricuspid regurgitation is a major consideration in transcatheter closure of VSD (< 2%). The impingement of the occluder on the valve leaflets by interfering with chordae tendineae may cause instant tricuspid regurgitation. Consequently echocardiography and angiography are crucial for confirming the correct deployment of the device (2).


References


  • 1. Liu J, Wang Z, Gao L, Tan H, Zheng Q, Zhang M. A Large Institutional Study on Outcomes and Complications after Transcatheter closure of a Perimembranous-type ventricular septal defect in 890 cases. Acta Cardiol Sin. 2013;29:271-9.
  • 2. Holzer R, Balzer D, Cao QL, Lock K, Hijazi ZM, Amplatzer Muscular Ventricular Septal Defect I. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder: immediate and mid-term results of a U.S. registry. J Am Coll Cardiol. 2004;43(7):1257-63. [DOI] [PubMed]

Figure 1.

Transthorasic Four-chamber View

Figure 2.

Transthorasic Subcostal View

Figure 3.