Tricuspid Valve Perforation By Endocardial Pacing Electrode

Petterson, Sylvia R.; Singh, Jang Bahadur; Reeves, Guillermo; Kocot, Stanley L.

doi:10.1378/chest.63.1.125-a

Cited by 28 publications

(16 citation statements)

References 2 publications

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“…Isolated case reports have been noted of entrapment of a PPM lead in the tricuspid apparatus during implantation, resulting in avulsion or laceration of the tricuspid valve leaflets upon removal of the PPM lead (6 -11) and case reports of perforation of a tricuspid valve leaflet by a PPM (Table 4) (12)(13)(14)(15)(16)(17)(18). Echocardiographic detection of tricuspid regurgitation in patients with a PPM has been reported (19).…”

Section: Discussionmentioning

confidence: 99%

Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads

Lin¹,

Nishimura²,

Connolly³

et al. 2005

Journal of the American College of Cardiology

303

156

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Section: Discussionmentioning

confidence: 99%

Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads

Lin¹,

Nishimura²,

Connolly³

et al. 2005

Journal of the American College of Cardiology

303

156

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“…Postulates of specific mechanisms for TR from pacemaker leads include perforation or laceration of valve leaflets, 2–6,26 direct lead interference with valve closure 27 and formation of scar tissue or thrombus around the pacemaker leads or the TV impairing leaflet mobility 28 . These mechanisms are supported by the higher reported prevalence of TR in patients with several leads than in patients with only 1 lead 29,30 .…”

Section: Pathogenesismentioning

confidence: 99%

“…2,3 Severe TV dysfunction after pacemaker implantation due to perforation or laceration of valve leaflets has been reported. 2,[4][5][6][7] The adhesions generally involve the papillary muscles but can also affect TV leaflets.We report a patient in whom a new murmur prompted an echocardiogram examination that showed severe TV regurgitation with mild to moderate increase in pulmonary artery pressure. Adhesion of the TV posterior leaflet to the pacemaker lead was felt to be the etiology of the TR.…”

mentioning

confidence: 99%

Tricuspid Valve Malfunction and Ventricular Pacemaker Lead: Case Report and Review of the Literature

et al. 2006

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Pacemaker implantation can be associated with several complications, including myocardial perforation with or without pericardial effusion, venous thrombosis, vegetations of the tricuspid valve (TV) or pacing lead, and tricuspid regurgitation (TR). The TR is thought to be derived from deformity or perforation of the TV by the pacing lead or secondary to atrioventricular discordance with asynchronous ventricular pacing. Severe TR can be deleterious to the patient because it raises the central venous pressure by increasing the right sided preload. Chronically, the increase in right sided blood volume can result in an increase in the right atrial pressure leading to a decrease in venous return and low cardiac output. Severe TR from leaflet adhesion to the pacemaker lead has not been reported before. With the aging of the population and the expanding use of pacemakers and implantable cardioverter defibrillators (ICD) in clinical practice, this complication may be seen more frequently. We present a patient diagnosed with severe TR, years after his pacemaker implantation. His TR was thought to be caused by adhesion of the tricuspid valve to his pacemaker lead.

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“…Mechanisms that have been reported previously include obstruction to leaflet closing, perforation, and laceration. [1][2][3][4][5]12,13 Lin et al 7 found that PPM-related tricuspid malfunctions were caused by various mechanisms; the largest subset of patients (39%) had lead impingement only of the tricuspid valve leaflets at surgery, but other mechanisms included adhesion of the PPM or ICD lead to a tricuspid valve leaflet (34%), leaflet perforation (17%), and entanglement of the tricuspid valve apparatus (10%). On that basis, insufficient valve closure may be the main cause of PPM-lead-related TR, as shown by our data.…”

Section: Mechanism Of Lead-related Trmentioning

confidence: 99%

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mentioning

confidence: 99%

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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Tricuspid Valve Perforation By Endocardial Pacing Electrode

Cited by 28 publications

References 2 publications

Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads

Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads

Tricuspid Valve Malfunction and Ventricular Pacemaker Lead: Case Report and Review of the Literature

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

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