Pacemaker lead-related tricuspid stenosis successfully treated with percutaneous balloon valvuloplasty guided by 3D echocardiography

Pacemaker Lead–Induced Tricuspid Valve Stenosis?

“…The mechanical damage can be caused by lead perforation, lead adherence and tethering, lead loop restricting the opening, and adhesion to subvalvular apparatus. [6][7][8] In the present case no findings indicated a mechanical obstruction due to loop formation of the PM lead, and the cause of TS was considered likely to be due to mechanical damage of the endothelium of the valve with induction of inflammation and fibrosis leading to the development of TS. In addition, no thrombus material was demonstrated at the TV.…”

“…Therefore, it is of great importance to use a multidisciplinary and multimodality approach, which can provide anatomical and functional data, to thoroughly evaluate the degree of stenosis and plan the optimal treatment strategy. 8,9 With the use of a transthoracic echocardiography we were able to establish TS as a working diagnosis for the patient. To further characterize the TS and confirm the diagnosis, 3D TEE offered a more accurate TV area and a more detailed anatomical characterization of the valve pathology.…”

Severe Tricuspid Stenosis Secondary to Permanent Pacemaker Lead

“…The likely underlying mechanism is adherence between the lead and the sub-valvular tissue causing mechanical irritation or fibrosis secondary to leaflet perforation and/or laceration [7,8]. Occasionally the permanent pacemaker lead forms a loop in the right ventricle which predisposes to adhesions and reactive fibrosis [8,[10][11][12][13][14]. However, cases have been reported of TS with no discernible lead looping or leaflet perforation [15].…”