Percutaneous Management of Recurrent Postsurgical Right Atrial Cicatricial Stenosis Causing Supratricuspid Obstruction.

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.