CLINICAL RESEARCH: HEART RHYTHM DISORDER
Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads
Grace Lin, MD*,
Rick A. Nishimura, MD, FACC*,*,
Heidi M. Connolly, MD, FACC*,
Joseph A. Dearani, MD ,
Thoralf M. Sundt, III, MD and
David L. Hayes, MD, FACC*
* Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Manuscript received July 28, 2004;
revised manuscript received December 24, 2004,
accepted February 1, 2005.
* Reprint requests and correspondence: Dr. Rick A. Nishimura, Mayo Clinic, Gonda 5-468 East, 200 First Street SW, Rochester, Minnesota 55905. (Email: nishimura.rick{at}mayo.edu).
OBJECTIVES: We report a series of patients with severe tricuspid valve regurgitation due to a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead.
BACKGROUND: Severe tricuspid regurgitation caused by a PPM or ICD lead is an under-recognized but treatable etiology of severe right heart failure.
METHODS: We reviewed the records of 41 patients who underwent tricuspid valve operation for severe tricuspid regurgitation caused by previously placed PPM or ICD leads.
RESULTS: During surgery, severe tricuspid regurgitation was found to be caused by the PPM or ICD leads in all 41 patients. There was a perforation of the tricuspid valve leaflet by the PPM or ICD lead in 7 patients, lead entanglement in the tricuspid valve occurred in 4 patients, lead impingement of the tricuspid valve leaflets occurred in 16 patients, and lead adherence to the tricuspid valve occurred in 14 patients. The septal leaflet was most often perforated (6 of 7). In the preoperative evaluation, valve malfunction due to the PPM or ICD lead was diagnosed preoperatively in only 5 of 41 (12%) patients by transthoracic echocardiography. All patients underwent successful tricuspid valve operation (22 tricuspid valve replacement), with one perioperative death occurring. During follow-up (range, 1 to 99 months), there was one patient who died from left-sided heart failure and three patients died of other causes. The remaining patients showed improvement in signs and symptoms of heart failure.
CONCLUSIONS: Damage to the tricuspid valve by PPM or ICD leads may result in severe symptomatic tricuspid regurgitation and may not be overtly visualized by echocardiography. This etiology should be considered when evaluating patients with severe right heart failure after PPM or ICD implantation.
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Abbreviations and Acronyms
| | ICD = implantable cardioverter-defibrillator | | PPM = permanent pacemaker |
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