title: [Alternatives to chronic cardiac stimulation in patients with mechanical tricuspid prosthesis and atrioventricular block].
abstract: 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.
authors.affiliation: Servicio de Hemodinamia y Electrofisiología Clínica. CMN 20 de Noviembre del ISSSTE, México, D.F.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Robledo Nolasco
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Buenfil Medina
authors.forename: Jaime
authors.initials: J
authors.lastname: Soto Solís
authors.forename: Neil
authors.initials: N
authors.lastname: Juárez Pelcastre
authors.forename: Gregorio
authors.initials: G
authors.lastname: Zaragoza Rodríguez
authors.forename: Jesús
authors.initials: J
authors.lastname: Flores Flores
authors.forename: José Luis
authors.initials: JL
authors.lastname: Sánchez Pazaran
authors.forename: Mario
authors.initials: M
authors.lastname: Blanco Canto
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cortés García
authors.forename: Vidal Efrén
authors.initials: VE
authors.lastname: Reyes Barrera
authors.forename: Carlos Enrique
authors.initials: CE
authors.lastname: Padilla Parga
mesh_terms: D005260:Female; D006327:Heart Block / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D014261:Tricuspid Valve