Pacemaker Lead Prolapse through the Pulmonary Valve in Children

Abstract

Prolapse of transvenous pacing leads into the pulmonary artery can occur when excess slack is left for growth. Leads can often be repositioned, but may require extraction and replacement, particularly if chronically implanted and adherent to valve apparatus. Lead revision does not always resolve pulmonary insufficiency, potentially leaving permanent valve damage.

Symptomatic pulmonary regurgitation secondary to redundant transvenous lead prolapse

“…The number of CHD CIED implants has steadily grown over the last few decades [1]. New techniques and more sophisticated devices have played an important role in the expanded application of these devices in the care of these patient population [4,6].…”

“…The use of cardiac implantable electronic devices (CIEDs) with transvenous leads (TVLs) in pediatric and congenital heart disease (CHD) patients has substantially increased over the last three decades [1][2][3]. Despite their benefits, challenges remain that are inherent to TVLs, their implantation and follow-up in growing patients, mainly those with unconventional cardiac structural anatomy [3,4].…”

“…Despite their benefits, challenges remain that are inherent to TVLs, their implantation and follow-up in growing patients, mainly those with unconventional cardiac structural anatomy [3,4]. In young patients, it is common practice to introduce additional slack to compensate for anticipated growth; however, redundant lead slack can result in mechanical and hemodynamic complications [1][2][3][4][5].…”

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

“…239,240,242 Specific complications may be more prevalent based on anatomy and size, such as increased subpulmonary AV valve regurgitation in transposition of the great arteries, or increased risk of tricuspid or pulmonary valve involvement related to excess lead slack left for growth in smaller children. [243][244][245][246][247][248] Additionally, although patient age and size have not been shown to predict venous occlusion, more vigorous fibrous adhesions have been implicated in younger patients. 249 Due to the complexities and potential for serious events in this population, lead extractions should only be performed in centers with an institutional commitment to the development and maintenance of a collaborative team.…”

“…[264][265][266][267][275][276][277] It is reasonable to consider lead surveillance with chest X-ray in the acute postimplant period and to consider repeating every 1-3 years according to growth. 241,247 7. Special Considerations…”