Pacemaker Lead-Induced Severe Tricuspid Valve Stenosis

Abstract

A 73-year-old man had a DDD pacemaker implanted in 1991 for symptomatic high-degree atrioventricular block. Because of atrial lead dysfunction, a new atrial lead was implanted in 1998. Ten years later, the patient experienced unexplained ascites and edema with progressive exertional dyspnea, for which he was referred. Chest radiography showed a loop of the ventricular lead at the level of the tricuspid valve (Figure 1). Transthoracic echocardiography demonstrated an enlarged right atrium. The mean diastolic gradient across the tricuspid valve was 15 mm Hg with a peak pressure drop of 29 mm Hg without tricuspid regurgitation (Figure 2). No other abnormalities were found. Transesophageal echocardiogram revealed looping of one of atrial leads at the level of the tricuspid valve but could not visualize the exact anatomic position of the leads and the cause of the tricuspid valve stenosis (Figure 3).A cardiac computed tomography (CT) revealed 2 atrial leads in the right atrial free wall. However, the ventricular

Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease

“…Endocardial leads crossing the TV can damage (through stenosis or regurgitation) [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] and be damaged by (through insulation abrasion [11] , [14] or conductor fracture [15] ) the valve, especially after surgical correction of severe pre-existent disease [16] . Tricuspid regurgitation is more common and severe in the presence of transvenous leads, and is then associated with increased mortality [17] , [18] , [19] .…”

Transvenous valve‐in‐valve replacement preserving the function of a transvalvular defibrillator lead

“…Stenosis of a tricuspid bioprosthetic valve is common after 13 years although accelerated dysfunction after lead implantation is sometimes reported . When a transvalvular lead is present and a new valve needs to be implanted, several approaches can be considered.…”

Right-sided valve disease

“…Carcinoid syndrome can cause valvular oxidative stress because of elevated circulating levels of serotonin , which can lead to fibrosis and subsequent TS, although TR is more common (Figures and ) . A number of reports of pacemaker induced TS have appeared, sometimes because of lead adhesions . Auscultation of the valve lesion itself is difficult because of the low pressure gradient between the RA and RV, and detection of the classical murmur of TS (a diastolic rumble at the lower parasternal border) is exceedingly rare without a prior echocardiogram to provide the diagnostic clue.…”