Percutaneous Management of Recurrent Postsurgical Right Atrial Cicatricial Stenosis Causing Supratricuspid Obstruction.
- 1Heart Institute (InCor), Universidade de São Paulo (USP), São Paulo, Brazil.
- 2Heart Institute (InCor), Universidade de São Paulo (USP), São Paulo, Brazil. Electronic address: [email protected].
Abstract
Background
Postsurgical right atrial cicatricial stenosis is a rare iatrogenic complication following extensive atrial reconstruction. When located above the tricuspid valve, this fibrotic tissue may cause supratricuspid obstruction, producing symptoms and hemodynamic findings similar to tricuspid stenosis.Case summary
A 41-year-old man with a history of complex atrial reconstruction using bovine pericardium and a Dacron graft presented with progressive dyspnea 1 year postoperatively. Echocardiography revealed a cicatricial supratricuspid membrane with a peak gradient of 18 mm Hg. Percutaneous balloon dilation was performed with immediate hemodynamic improvement; however, obstruction recurred 3 times at intervals of 8, 6, and 6 months, each successfully managed with repeat dilation.Discussion
Given the prohibitive surgical risk conferred by 2 prior complex sternotomies, prosthetic atrial reconstruction, and significant systemic comorbidities, as determined by multidisciplinary Heart Team consensus, a percutaneous strategy was adopted. Each intervention achieved gradient reduction; however, fibrotic remodeling of the cicatricial tissue led to recurrent obstruction over time.
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BibTeX
@article{mejia2026percutaneous,
title = {{Percutaneous Management of Recurrent Postsurgical Right Atrial Cicatricial Stenosis Causing Supratricuspid Obstruction.}},
author = {Hernán Patricio García Mejía and Marco Antonio Smiderle Gelain and Pedro Sérgio Soares Jallad and Andre Moreira Nicolau and Isabella Diniz Novaes and Kevin Rafael De Paula Morales and Marcelo Luiz Campos Vieira and Carlos M Campos and Ludhmila Abrahao Hajjar and Alexandre Abizaid and Fabio S de Brito},
journal = {JACC. Case reports},
year = {2026},
month = oct,
doi = {10.1016/j.jaccas.2026.110195},
url = {https://europepmc.org/article/MED/42847577},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Percutaneous Management of Recurrent Postsurgical Right Atrial Cicatricial Stenosis Causing Supratricuspid Obstruction.
AU - Hernán Patricio García Mejía
AU - Marco Antonio Smiderle Gelain
AU - Pedro Sérgio Soares Jallad
AU - Andre Moreira Nicolau
AU - Isabella Diniz Novaes
AU - Kevin Rafael De Paula Morales
AU - Marcelo Luiz Campos Vieira
AU - Carlos M Campos
AU - Ludhmila Abrahao Hajjar
AU - Alexandre Abizaid
AU - Fabio S de Brito
PY - 2026
DA - 2026/10/01
JO - JACC. Case reports
DO - 10.1016/j.jaccas.2026.110195
UR - https://europepmc.org/article/MED/42847577
AB - Background Postsurgical right atrial cicatricial stenosis is a rare iatrogenic complication following extensive atrial reconstruction. When located above the tricuspid valve, this fibrotic tissue may cause supratricuspid obstruction, producing symptoms and hemodynamic findings similar to tricuspid stenosis.Case summary A 41-year-old man with a history of complex atrial reconstruction using bovine pericardium and a Dacron graft presented with progressive dyspnea 1 year postoperatively. Echocardiography revealed a cicatricial supratricuspid membrane with a peak gradient of 18 mm Hg. Percutaneous balloon dilation was performed with immediate hemodynamic improvement; however, obstruction recurred 3 times at intervals of 8, 6, and 6 months, each successfully managed with repeat dilation.Discussion Given the prohibitive surgical risk conferred by 2 prior complex sternotomies, prosthetic atrial reconstruction, and significant systemic comorbidities, as determined by multidisciplinary Heart Team consensus, a percutaneous strategy was adopted. Each intervention achieved gradient reduction; however, fibrotic remodeling of the cicatricial tissue led to recurrent obstruction over time.
SN - 2666-0849
ER -