However, our attempt was unsuccessful (Fig. 2B), because even though were able to entrap the stent by snaring it, we were unable to pull it back through the guiding catheter. The stent was deformed and caught in the tricuspid valve so we had to terminate the procedure to avoid valve damage. Three days later, the endovascular stent was eliminated by open heart surgery (Fig. 3), and the damaged tricuspid valve was corrected by tricuspid valve posteroseptal commissuroplasty. Follow-up echocardiography showed no significant Inhibitors,research,lifescience,medical tricuspid valve stenosis and regurgitation.

Vmax of TR was 236 cm/s, LVEDD decreased to 48 mm and EF reached 80% and E/E’ was 10.8. Also, the symptoms of heart failure improved overall. Fig. 2 A: Right anterior oblique view of fluoroscopy shows the expended stent (arrows) in the right ventricle.

B: During percutaneous intervention for stent retrieval by snaring, the stent was deformed and caught by the tricuspid valve. Fig. 3 The stent strut which retrieved by open heart surgery. Inhibitors,research,lifescience,medical Discussion Complications of stent deployment include obstruction, recurrence due to intimal hyperplasia, vessel perforation, misplacement, and migration. Migration is rare but it can be life-threatening if the stent reaches the heart and pulmonary artery.7),8) Migration of stents from the superior vena cava Inhibitors,research,lifescience,medical to the innominate vein,9) right atrium,10) right ventricle,11-13) and pulmonary GSK1363089 supplier artery,14),15) after endovascular stenting for superior vena cava syndrome have been reported Inhibitors,research,lifescience,medical previously. Predisposing factors for stent migration in the condition of superior vena cava obstruction include 1) poor choice of lesion, 2) inadequate sizing of the stent, 3) inaccurate

positioning of the stent, 4) effect of cardiac motion, 5) inaccurate vessel measurement, 6) cases in which the disease is expected to be resolved with Inhibitors,research,lifescience,medical treatment, for example, Hodgkin’s lymphoma, 7) stent deployment system, and 8) delivery route.16) If stent migration has occurred, the migrated stents have to be removed to prevent complications that include thrombosis, vessel trauma, and perforation. In case of migrated stent reached to the cardiac structures, Thymidine kinase it may cause myocardial injury resulting in arrhythmias, injury to valves, and papillary muscles, and rarely myocardial perforation causing hemopericardium and cardiac tamponade.17),18) The migrated stents can be managed either percutaneously or by open surgery. Taylor et al.16) described four different strategies for endovascular approaches of stent migration into the right atrium. These included: 1) snaring the stent directly, 2) angioplasty balloon-assisted snaring of the stent, 3) guide wire-assisted snaring of the stent, and 4) superior vena cava-to-inferior vena cava bridging stent.