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Right ventricular outflow obstruction caused by cocoon duct occluder used for closure of ruptured sinus of valsalva aneurysm


1 Department of Anaesthesiology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
2 Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
3 Department of Cardiovascular and Thoracic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India

Correspondence Address:
Aanchal Dixit
Department of Anaesthesiology, Medanta Hospital, Lucknow, Uttar Pradesh – 226014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_184_19

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Year : 2021  |  Volume : 24  |  Issue : 3  |  Page : 422-424

 

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Hemolytic anemia and right ventricular outflow tract obstruction following device closure of ruptured sinus of Valsalva have seldom been reported in isolated case reports, and exact incidence is not known. A gentleman presented with severe delayed hemolytic anemia following the use of cocoon duct occluder for ruptured sinus of Valsalva. Right ventricular outflow tract obstruction of unclear etiology was also reported on transthoracic echocardiography, necessitating retrieval of the device and surgical closure of the defect. Intraoperative transesophageal echocardiography (TEE) showed right ventricular outflow obstruction by the cocoon device itself with a normal pulmonary valve. In this report, we emphasize that improper device selection for closure of ruptured sinus of Valsalva aneurysm, may lead to delayed leaks across the device, which can gradually progress causing hemolytic anemia and high gradient across the right ventricular outflow tract. Intraoperative TEE helped to delineate the cause of right ventricular outflow tract obstruction.






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1 Department of Anaesthesiology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
2 Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
3 Department of Cardiovascular and Thoracic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India

Correspondence Address:
Aanchal Dixit
Department of Anaesthesiology, Medanta Hospital, Lucknow, Uttar Pradesh – 226014
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_184_19

Rights and Permissions

Hemolytic anemia and right ventricular outflow tract obstruction following device closure of ruptured sinus of Valsalva have seldom been reported in isolated case reports, and exact incidence is not known. A gentleman presented with severe delayed hemolytic anemia following the use of cocoon duct occluder for ruptured sinus of Valsalva. Right ventricular outflow tract obstruction of unclear etiology was also reported on transthoracic echocardiography, necessitating retrieval of the device and surgical closure of the defect. Intraoperative transesophageal echocardiography (TEE) showed right ventricular outflow obstruction by the cocoon device itself with a normal pulmonary valve. In this report, we emphasize that improper device selection for closure of ruptured sinus of Valsalva aneurysm, may lead to delayed leaks across the device, which can gradually progress causing hemolytic anemia and high gradient across the right ventricular outflow tract. Intraoperative TEE helped to delineate the cause of right ventricular outflow tract obstruction.






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