Intracardiac Migration of an Iliac Venous Stent to the Right Ventricle Causing Tricuspid Regurgitation Managed by Surgical Extraction: A Case Report

Venous stenting is increasingly used in the management of chronic obstructive venous disease, particularly in severe post-thrombotic syndrome, iliocaval obstruction, and extrinsic iliac vein compression. Although this technique is generally effective and safe, rare but potentially serious complications may occur, including stent migration to the right-sided cardiac chambers. We report the case of a 72-year-old man with a history of deep venous thrombosis treated by left iliac venous stenting approximately 20 years earlier. He presented with a cough and hemoptysis evolving over three months. Chest computed tomography angiography revealed a suspicious right basal pulmonary lesion, which remained under investigation, and an intracardiac foreign body corresponding to a migrated venous stent within the right-sided cardiac chambers. On admission to the intensive care unit, the patient had clinical signs of right-sided heart failure. Transthoracic echocardiography confirmed a stent straddling the right atrium and right ventricle, in contact with the septal leaflet of the tricuspid valve and causing moderate tricuspid regurgitation. Because of its entanglement with the tricuspid valve apparatus, endovascular retrieval was considered unsuitable. The patient underwent surgical extraction through median sternotomy under cardiopulmonary bypass. The postoperative course was uneventful, and the patient was discharged on postoperative day nine. At three-week follow-up, he remained asymptomatic and clinically stable. Intracardiac migration of a venous stent is rare but may lead to severe complications, including valvular injury, arrhythmia, embolization, perforation, and heart failure. This case highlights the importance of appropriate stent sizing, careful deployment, and long-term clinical and imaging surveillance after venous stenting.