Tricuspid Valve Perforation by Permanent Pacemaker Lead

Abstract

Tricuspid valve perforation with pacemaker lead is one of the extremely rare complications of transvenous pacemaker implantation. Approximately all reported cases have been diagnosed at autopsy. The authors present a case of tricuspid valve perforation caused by pacemaker lead that was diagnosed during cardiac surgery and treated successfully by removing the lead and suturing the tricuspid valve.

Tricuspid valve repair in the presence of a permanent ventricular pacemaker lead

“…There have been few case reports of PPL-related TR published in the literature [5][6][7][8] showing that this pathology is due to various mechanisms.…”

“…The mechanism of severe TR was due to leaflet malcoaptation and they hypothesised that the AV surgery was responsible for the conformational changes between cardiac chambers, TV and the PPLs, causing severe TR. The other mechanisms reported are either immobilisation or perforation of the anterior tricuspid leaflet or entrapment of the lead shaft in the fused septal and posterior tricuspid leaflets [6][7][8].…”

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

“…One pilot study (18) showed improved symptoms and ventricular function when biventricular pacing was instituted in patients with presumed RV pacing-induced LV failure. In addition, case reports suggest that rightsided pacemaker wires may entrap or perforate the tricuspid valve, presenting with severe insufficiency (or even stenosis) and isolated RHF (19,20). Tricuspid insufficiency may also occur following RV biopsy, presumably as a result of damage to the chordae and loss of tricuspid valve coaptation (21).…”

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

“…TV perforation after lead implantation can result in TV regurgitation . In case reports published on lead‐related TV perforations, the time period in which patients present with symptoms after implantation is from four months to 14 years (Table ) . The unique characteristic of our case is that the diagnosis of perforation was only two weeks after implantation.…”

“…Passage of endocardial leads through the TV can perforate a leaflet, leading to severe TV injury, and regurgitation . In the literature, patients present with symptoms of TV regurgitation from leaflet perforation four months to 14 years after PPM or ICD implantation (Table ) . We present a case of acute severe TV regurgitation due to perforation of the septal leaflet two weeks after ICD implantation and review the literature associated with this complication.…”