{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:02:59Z","timestamp":1787169779809,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_184_19","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T06:11:56Z","timestamp":1680243116000},"page":"422-424","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Right ventricular outflow obstruction caused by cocoon duct occluder used for closure of ruptured sinus of valsalva aneurysm"],"prefix":"10.4103","volume":"24","author":[{"given":"Rashmi","family":"Soori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aanchal","family":"Dixit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhat","family":"Tewari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surendra K.","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-33-20240901","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1093\/eurheartj\/ehq323","article-title":"Transcatheter closure of ruptured sinus of Valsalva aneurysm using the Amplatzer duct occluder: Immediate results and mid-term follow-up","volume":"31","author":"Kerkar","year":"2010","journal-title":"Eur Heart J"},{"key":"R2-33-20240901","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1055\/s-0034-1396948","article-title":"Percutaneous transcatheter closure of ruptured sinus of Valsalva aneurysm: Immediate result and long-term follow-up","volume":"24","author":"Sinha","year":"2015","journal-title":"Int J Angiol"},{"key":"R3-33-20240901","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1540-8183.2004.01714.x","article-title":"Transcatheter closure of ruptured sinus of Valsalva aneurysm","volume":"17","author":"Arora","year":"2004","journal-title":"J Interv Cardiol"},{"key":"R4-33-20240901","doi-asserted-by":"crossref","first-page":"e105357","DOI":"10.1371\/journal.pone.0105357","article-title":"Theory to predict shear stress on cells in turbulent blood flow","volume":"9","author":"Morshed","year":"2014","journal-title":"PLoS One"},{"key":"R5-33-20240901","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.echo.2013.07.009","article-title":"Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists","volume":"26","author":"Hahn","year":"2013","journal-title":"J Am Soc Echocardiogr"},{"key":"R6-33-20240901","doi-asserted-by":"crossref","first-page":"165","DOI":"10.4250\/jcvi.2018.26.e19","article-title":"Early experiences using cocoon occluders for closure of a ventricular septal defect","volume":"26","author":"Park","year":"2018","journal-title":"J Cardiovasc Imaging"},{"key":"R7-33-20240901","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.actbio.2013.12.003","article-title":"Biomaterials and design in occlusion devices for cardiac defects: A review","volume":"10","author":"Huang","year":"2014","journal-title":"Acta Biomater"},{"key":"R8-33-20240901","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1161\/CIRCULATIONAHA.115.019987","article-title":"Relative risk factors for cardiac erosion following transcatheter closure of atrial septal defects: A case-control study","volume":"133","author":"McElhinney","year":"2016","journal-title":"Circulation"},{"key":"R9-33-20240901","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/chd.12572","article-title":"Clinical outcomes of percutaneous or surgical closure of ruptured sinus of Valsalva aneurysm","volume":"13","author":"Xiao","year":"2018","journal-title":"Congenital Heart Dis"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.ACA_184_19","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:12:54Z","timestamp":1787166774000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.ACA_184_19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":9,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_184_19","relation":{},"ISSN":["0971-9784"],"issn-type":[{"value":"0971-9784","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}