[Alternatives to chronic cardiac stimulation in patients with mechanical tricuspid prosthesis and atrioventricular block].
One of the complications of tricuspid valve replacement (TVR) is the complete heart block (CHB). In these patients an epicardial permanent pacemaker is frequently used but its insertion is another major operation and higher thresholds are needed. Two patients are reported, both women, with rheumatic heart disease and TVR who required a permanent pacemaker because they developed CHB. The first patient underwent mitral valve replacement with a disc valve seventeen years before and TVR recently. A single chamber pacemaker was implanted. Left ventricular pacing was achieved through the great cardiac vein. The acute and chronic pacing thresholds were adequate. The second patient underwent tricuspid and mitral replacement with a Starr-Edwards (SE) valve. Eighteen years later this patient had atrial fibrillation with slow ventricular response and heart failure. The pacemaker lead had to be inserted across the tricuspid SE valve because ventricle pacing through the coronary veins was unsuccessful. The endocardial pacing resulted in mild tricuspid regurgitation and has continued the same way for four years. To conclude, ventricle pacing through the coronary veins is safe, produces excellent results and fewer complications. On the other hand, ventricle pacing across a prosthetic tricuspid valve remains questionable because of possible damage to the prosthesis itself leading to valve insufficiency and because of damage to the pacing lead.
Robledo Nolasco
Rogelio
R
Servicio de Hemodinamia y Electrofisiología Clínica. CMN 20 de Noviembre del ISSSTE, México, D.F.
Buenfil Medina
José Carlos
JC
Soto Solís
Jaime
J
Juárez Pelcastre
Neil
N
Zaragoza Rodríguez
Gregorio
G
Flores Flores
Jesús
J
Sánchez Pazaran
José Luis
JL
Blanco Canto
Mario
M
Cortés García
Alejandro
A
Reyes Barrera
Vidal Efrén
VE
Padilla Parga
Carlos Enrique
CE
D005260:Female; D006327:Heart Block / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D014261:Tricuspid Valve