Perforated Tricuspid Valve Leaflet Resulting from Defibrillator Leads: A Review of the Literature

Abstract

Tricuspid valve (TV) perforation is a rare complication after implantable cardioverter defibrillator (ICD) and permanent pacemaker implantation. In reported cases of lead-related TV perforations, patients' present with symptoms months to years postimplantation. We describe a case where a patient presented with signs of severe TV regurgitation secondary to traumatic perforation of the septal leaflet two weeks after ICD implantation and review of the literature associated with this complication.

Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

“…Therefore, this study provides further information regarding the prevalence, predictors, and https://doi.org/10.1371/journal.pone.0235230.g002 The etiology and mechanism of PMTR are not fully elucidated. Earlier studies mainly showed direct damage to TV leaflet or subvalvular apparatus during pacemaker lead implantation can lead to PMTR by perforation of TV leaflet, laceration, or injury of chordae tendineae [15][16][17]. However, more recent studies have demonstrated that mechanical interference of TV leaflet or subvalvular structures which resulted in incomplete coaptation of TV [3,5].…”

Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads

“…There are multiple reports of patients who have been found to have TV leaflets perforated by their RV or even right atrial leads . Clinical manifestations can involve impaired leaflet mobility or sequelae of the long‐term fibrotic response that later occurs between the lead and the injured valve (promoting stenosis or regurgitation).…”

“…In one series, the septal leaflet was involved in six out of seven cases of perforation . Clinical deteriorations can occur from 2 to 3 weeks to several years later . In an attempt to minimize direct trauma to the leaflets, guidance documents on lead implantation techniques suggest a “prolapsing” technique (instead of “drop‐down” or “direct crossing”) when traversing the TV …”

A novel technique for lead sparing tricuspid valve replacement in the case of a transvenous ICD lead

“…On the other hand, there are many reports on native, as well as bio‐prosthetic valve, complications in case of transvalvular implantation . In particular, TV stenosis, due to stuck valvular leaflets, perforation of a leaflet during implantation and papillary muscle perforation has been reported …”