Perforation of the Tricuspid Valve by a Transvenous Pacemaker

Gould, Lawrence; Reddy, C.V.R.; Yacob, Usama; Teich, Marvin; DeMartino, Anthony; DePalma, Dominick; Gomprecht, Robert F.

doi:10.1001/jama.1974.03240010054032

Cited by 43 publications

(32 citation statements)

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“…The mechanisms of PPM-related TR include leaflet perforation or laceration, interference of coaptation by the lead, asynchronous RV activation from apex to base, and entrapment and encapsulation of the PPM lead by scar tissue. [1][2][3][4][5][6] Panigua et al 5 have reported an increased incidence of moderate-to-severe TR in patients with transvenous PPM compared with age-and sex-matched controls, and they suggested that PPM lead may aggravate TR. This phenomenon was noted in the present patient, who had moderate TR before placement of the PPM and in whom the symptoms of right-heart failure appeared gradually 6 years later.…”

Section: Discussionmentioning

confidence: 99%

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Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Chen

Wang

Chern

et al. 2007

Circ J

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ight heart failure because of tricuspid regurgitation (TR) after permanent pacemaker (PPM) has been reported. [1][2][3][4][5][6] Conventional 2-dimensional (D) echocardiography (echo), though very important for detecting TR, is quite limited in depicting the precise anatomical relationship between the tricuspid leaflets and PPM lead shaft. 2 This relationship may determine the pathogenesis of TR and realization of it may help determine the policy of management. In this report, with the assistance of 3D echo, the structure of the tricuspid valve, its incompetence and the entrapment of the PPM lead shaft in the valve were precisely delineated. Case ReportA 58-year-old man underwent implantation of a transvenous VVIR PPM for atrial fibrillation and complete heart block 9 years ago. Prior to PPM, echocardiography showed moderate TR, with a TR area of 16.6 cm 2 and a right atrial (RA) area of 28.8 cm 2 , and normal systolic function of both ventricles. Three years after PPM implantation, 2D echo showed aggravation of TR with a TR area of 19.4 cm 2 and a RA area of 37.4 cm 2 . Since then, he had abdominal fullness and edema of both legs. These symptoms gradually became aggravated. Follow-up transthoracic echocardiography was performed by using a Philips SONOS 7500 (Philips Medical Systems, Eindhoven, Netherlands) and pyramid-shaped full-volume 3D images of the right ventricle (RV) were acquired from between the left parasternal border and the apical window with a 4 MHz and 4× matrix transducer under ECG gating while the patient gently held his breath. The 2D echo revealed slightly impaired systolic function of the left ventricle with abnormal septal wall motion and mild Circulation Journal Vol.71, July 2007 mitral regurgitation. The RV, RA and inferior vena cava were dilated, and RV function was normal (Fig 1A). Tethering of the septal leaflet of tricuspid valve was observed, together with no coaptation of thes leaflets, thus causing severe TR (Fig 1B). The maximal area of TR was 42.1 cm 2 and that of RA 64.6 cm 2 . The transtricuspid systolic pressure gradient was 12 mmHg. However, the relationship between the tricuspid valve and the PPM lead could not be observed on the multiple views of 2D echo (Figs 1C,D).After being cropped in from the apex toward the base, the full-volume 3D echo showed that the shaft of the PPM lead was entrapped in the thickened, fibrotic and fused posterior and septal leaflets (Fig 2A), which could not coapt during systole, and the vena contracta was well seen (Fig 2A, arrowhead). During diastole, the anterior tricuspid leaflet opened freely. The anterior two-thirds of the septal leaflet was tethered, but not fixed, and could be pushed open slightly. The remaining one-third of the septal leaflet and the entire posterior leaflet was thickened, tethered and frozen (Fig 2B). When the full-volume 3D pyramid was cropped in from the RV free wall, the entrapment of the PPM shaft in the fused septal and posterior leaflets and the free movements of anterior tricuspid leaflet were noted clearly during ...

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Conventional 2-dimensional (D) echocardiography (echo), though very important for detecting TR, is quite limited in depicting the precise anatomical relationship between the tricuspid leaflets and PPM lead shaft. 2 This relationship may determine the pathogenesis of TR and realization of it may help determine the policy of management.…”

mentioning

confidence: 99%

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Chen

Wang

Chern

et al. 2007

Circ J

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Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker Leads

Seo

Ishizu

Nakajima

et al. 2008

Circ J

104

111

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ignificant tricuspid regurgitation (TR) has been reported in patients with a permanent pacemaker (PPM), [1][2][3][4][5] and the leads of such a device or those of an implantable cardioverter defibrillator (ICD) can be the primary cause of symptomatic TR. 6,7 However, in the clinical setting, the diagnosis of lead-induced TR can be challenging because conventional 2-dimensional echocardiography (2-DE) has limitations in identifying the anatomical relationship between the lead and the tricuspid leaflets. 7 The 3-dimensional echocardiography (3-DE) has been recently developed for assessing tricuspid valve morphology and pathology, including TR, [8][9][10][11] and case reports on its utility in the diagnosis of PPM-and ICD-lead-related TR have been published. 12,13 However, the ability of 3-DE to identify both the anatomical lead route through the tricuspid valve and lead-induced valve malfunction has not been studied systematically. Methods Patient PopulationIn 87 patients with PPM, ICD or cardiac resynchroniza- Circulation Journal Vol.72, September 2008tion therapy device, 3-DE studies were performed to evaluate the route of the leads and the presence of lead-related TR (Table 1). The underlying cardiac disease for which PPM implantation was required was complete or advanced atrioventricular block in 28 patients and sick sinus syndrome, including slow atrial fibrillation, in 22 patients, and for ICD implantation it was primary or secondary prevention of fatal cardiac arrhythmias in 17 patients. Cardiac resynchronization therapy devices with or without ICD were implanted in 20 patients with advanced heart failure. The study was approved by the local research ethics committee, and all patients gave written informed consent. Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker LeadsYoshihiro Seo, MD; Tomoko Ishizu, MD; Hideki Nakajima, RDCS*; Yukio Sekiguchi, MD; Shigeyuki Watanabe, MD; Kazutaka Aonuma, MD Background This study evaluated the usefulness of 3-dimensional echocardiography (3-DE) for identifying permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) lead-related symptomatic tricuspid regurgitation (TR). Methods and ResultsEighty-seven patients underwent 3-DE examination: 50 patients with PPM, 17 with ICD, and 20 with cardiac resynchronization therapy devices. TR severity was classified as trivial/mild, moderate, or severe according to the ratio of TR area to right atrium area. The 3-DE identified the lead route and position at the tricuspid valve in 82 patients (94.2%). In 5 patients, images without lead-induced artifacts could not be obtained. TR severity was trivial/mild in 50 patients, moderate in 20 patients, and severe in 12 patients. In all patients with trivial/mild TR and all but 1 patient with moderate TR, leads were positioned on the annulus side between leaflets. Lead-induced obstruction to tricuspid valve closing was identified in 1 patient with moderate TR and in 7 of 12 patients with severe TR: 4 patients had...

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“…Прямое повреждение структур ТК желудоч-ковым электродом, включая перфорацию створ-ки, хорд и папиллярных мышц, а также запуты-вание электрода в структурах клапана, может приводить как к возникновению выраженной ТР сразу после имплантации, так и к постепен-ному ее развитию в отдаленном периоде наблю-дения [9,[12][13][14][29][30][31]. Одним из самых не-обычных механизмов развития ТР в отдаленном послеоперационном периоде, встречающих-ся в литературе, является случай, описанный A. Loupy et al [15]: выраженная ТР у пациента диагностирована через 17 лет после первичной имплантации ААУ по поводу атриовентрику-лярной блокады, через 9 лет после имплантации второго желудочкового электрода и через 1 мес после протезирования аортального клапана.…”

Section: имплантация антиаритмических устройств является методом выбоunclassified

Tricuspid Valve Regurgitation After Antiarrhythmic Device Implantation

Кропоткин¹,

Ivanitskiy²

2017

Ann aritmol

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Perforation of the Tricuspid Valve by a Transvenous Pacemaker

Cited by 43 publications

References 5 publications

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker Leads

Tricuspid Valve Regurgitation After Antiarrhythmic Device Implantation

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