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

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.

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.

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.