title: Pacemaker lead prolapse through the pulmonary valve in children.
abstract: BACKGROUND
  Transvenous pacemaker leads in children are often placed with redundant lead length to allow for anticipated patient growth. This excess lead may rarely prolapse into the pulmonary artery and potentially interfere with valve function. We sought to determine the response to lead repositioning on pulmonary valve insufficiency.
  
  
  METHODS
  Retrospective reviews of demographics, lead type, implant duration, and radiography and echocardiography.
  
  
  RESULTS
  A total of 11 pediatric patients were identified with lead prolapse through the pulmonary valve, of which nine patients underwent procedures to retract and reposition the lead (age at implant 9 +/- 4 years, age at revision 13 +/- 4 years). The implant duration prior to revision was 4 +/- 3 years. Two leads required radiofrequency extraction sheaths for removal, two pulled back using a snare, while five leads were simply retracted and repositioned. Tricuspid regurgitation was none/trivial (three), mild (four), or moderate (two) and only two improved with repositioning or replacement. Pulmonary regurgitation preoperatively was mild (three), mild-moderate (two), or moderate (four) compared with trivial (three), mild (four), and moderate (two) after revision. Patients with longer-term implanted leads had less improvement in pulmonary insufficiency. Two patients had mild pulmonary stenosis from lead-related obstruction.
  
  
  CONCLUSIONS
  Prolapse of transvenous pacing leads into the pulmonary artery can occur when excess slack is left for growth. Leads can often be repositioned, but may require extraction and replacement, particularly if chronically implanted and adherent to valve apparatus. Lead revision does not always resolve pulmonary insufficiency, potentially leaving permanent valve damage.
authors: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. charles.berul@cardio.chboston.org
authors: Charles I
authors: CI
authors: Berul
authors: Juan
authors: J
authors: Villafane
authors: Dianne L
authors: DL
authors: Atkins
authors: Frank
authors: F
authors: Cecchin
authors: Joel A
authors: JA
authors: Kirsh
authors: James A
authors: JA
authors: Johns
authors: Ronald J
authors: RJ
authors: Kanter
authors: Peter P
authors: PP
authors: Karpawich
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011475:Prosthesis Failure; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies