|Year : 2019 | Volume
| Issue : 2 | Page : 62-63
Tricuspid valve dysfunction due to incarcerated right ventricular lead
Lili Xu1, Cuizhen Pan2, Xianhong Shu3, Junbo Ge1
1 Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
2 Shanghai Institute of Cardiovascular Diseases; Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
3 Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases; Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
|Date of Submission||03-Nov-2018|
|Date of Acceptance||14-Apr-2019|
|Date of Web Publication||26-Jun-2019|
Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032
Source of Support: None, Conflict of Interest: None
Here we report a case of severe tricuspid regurgitation related to the pacemaker lead incarcerated in the chordae tendinae, resulting in significantly reduced systolic function of right ventricular and right sided heart failure. The necessity of echocardiography is ignored in the follow-ups after pacemaker implantation, which may be useful for optimal lead placement.
Keywords: Heart failure, pacemaker, tricuspid valve dysfunction
|How to cite this article:|
Xu L, Pan C, Shu X, Ge J. Tricuspid valve dysfunction due to incarcerated right ventricular lead. Cardiol Plus 2019;4:62-3
| Introduction|| |
Tricuspid valve (TV) dysfunction associated with cardiac implantable electronic device has gained increasing recognition as having hemodynamic and clinical consequences.
| Case Report|| |
A 69-year-old woman was referred to our hospital with progressive shortness of breath and edema of lower extremity. She had a dual-chamber pacemaker implanted 4 years prior in another clinic center due to brady-tachy-arrhythmia syndrome. The electrocardiogram at the time of referral revealed normal function of the pacemaker. Transthoracic echocardiography (TTE) demonstrated tethered tricuspid leaflets and tricuspid incompetence related to the pacemaker lead incarcerated in the chordae tendineae (bold white arrow), resulting in extremely severe tricuspid regurgitation (TR), dilated right atrium and ventricle, and significantly reduced right ventricular systolic function [Figure 1]a. Tricuspid annular plane systolic excursion was 9 mm. The peak pressure gradient of TR was 17 mmHg, indicating normal pulmonary artery pressure [Figure 1]b. The incarcerated pacemaker lead was confirmed in the three-dimensional (3D) four-chamber apical view [Figure 1]c as well as in the 2D right ventricular inflow view [Figure 1]d. Remarkably dilated inferior vena cava was also detected. Cardiothoracic surgery was consulted for lead extraction and TV replacement, but the patient was not recommended as a candidate for the surgery, due to the long course of her disease. Heart transplantation was recommended, but the patient refused.
|Figure 1: (a) TTE demonstrated tethered tricuspid leaflets and tricuspid incompetence related to the pacemaker lead incarcerated in the chordae tendinea. (b) peak pressure gradient of TR. (c) incarcerated pacemaker lead in the three-dimensional (3D) four-chamber apical view. (d) incarcerated pacemaker lead and tricuspid incompetence in the 2D right ventricular inflow view|
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| Discussion|| |
Apart from regurgitation, tricuspid stenosis has also been reported to develop secondary to implantation of a permanent pacemaker lead. In the era of implantable device therapy, given the detrimental effect of significant TR on function and survival, any opportunity to minimize iatrogenic TR should be considered. These cases indicate the necessity of TTE in follow-ups after pacemaker implantation, which may be useful for optimal lead placement and avoiding a similar situation. Furthermore, research and development of cardiac implantable devices without a lead is in urgent need.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
This work was supported by grant #18ZR1436100 and Shanghai Sailing Program (18YF1404800) from the Science and Technology Committee Foundation of Shanghai.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Husain A, Raja FT, Fatallah A, Fadel B, Alsanei A, Raja FT, et al.
Tricuspid stenosis: An emerging disease in cardiac implantable electronic devices era. Case report and literature review. J Cardiol Cases 2017;15:190-3.
Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol 2017;69:2331-41.