title: Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation.
abstract: While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Management, Boston, Massachusetts.
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.forename: Angela
authors.initials: A
authors.lastname: Wang
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D018658:Ventricular Septal Rupture / Q000175:diagnosis / Q000628:therapy*
keywords: catheter intervention; echocardiography; post-infarction ventricular septal defect; tricuspid valve