Liver dysfunction as a rare presentation of ICD lead-induced tricuspid regurgitation: a case report

Abstract

Background Implanted cardiac devices with right ventricular leads can cause tricuspid regurgitation and subsequent heart failure. In these patients, congestive hepatopathy because of tricuspid regurgitation is well documented, however the presentation of liver dysfunction without overt heart failure is rare. Case Summary We report a case of a 56-year-old man with presumed hypertrophic cardiomyopathy, presenting with jaundice without signs of decompensated heart failure, eight years post implantation of dual chamber implantable cardiac defibrillator (ICD). A workup for abnormal liver function, including a liver biopsy, determined congestive hepatopathy as the cause. Cardiac imaging revealed severe tricuspid regurgitation caused by right ventricular ICD lead causing tricuspid valve malposition. Management included both tricuspid valve replacement and extraction of ICD and there was an excellent recovery. Discussion This is a rare case where severe tricuspid regurgitation and congestive hepatopathy secondary to an ICD lead presented with jaundice in the absence of signs of decompensated heart failure. In patients with an implanted cardiac device presenting with signs of liver dysfunction, congestive hepatopathy secondary to tricuspid regurgitation should be considered.