Severe tricuspid regurgitation due to entrapment of the anterior leaflet of the valve by a permanent pacemaker lead: role of real time three-dimensional echocardiography.
Pacemaker leads may impair tricuspid valve coaptation and they are a well-known cause of mild tricuspid regurgitation. Occasionally, right ventricular leads worsen tricuspid regurgitation over time and patients develop late-onset symptoms of right-sided heart failure. The exact mechanism of this clinical entity is rarely identifiable by 2D-echocardiography only. This case report details a patient with severe tricuspid regurgitation secondary to immobilization of the anterior leaflet of the tricuspid valve by a permanent ventricular pacing lead. The mechanism of regurgitation was clarified by real time three-dimensional echocardiography that showed the location of the ventricular lead and its interference with the tricuspid valve.
Nucifora
Gaetano
G
Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy. gnucifora@cardionet.it
Badano
Luigi P
LP
Allocca
Giuseppe
G
Gianfagna
Pasquale
P
Proclemer
Alessandro
A
Cinello
Margherita
M
Fioretti
Paolo M
PM
D000368:Aged; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery