Severe tricuspid valve stenosis secondary to pacemaker leads presenting as ascites and liver dysfunction: a complex problem requiring a multidisciplinary therapeutic approach.
Tricuspid stenosis secondary to ventricular pacemaker leads is uncommon. We present a unique case of iatrogenic tricuspid stenosis secondary to fusion of the valve leaflets to transvenous implanted pacing leads. This occurred in an adult with childhood repaired Tetralogy of Fallot and high grade surgical heart block following multiple pacemaker procedures. The case was complicated by superior vena cava (SVC) and innominate vein stenosis secondary to implanted pacing leads, severe tricuspid valve (TV) stenosis, perforation of the heart by one of the implanted transvenous ventricular pacing leads, prolapse of the transvenous atrial pacing lead into the right ventricle, and unusual coronary sinus anatomy. We describe a multidisciplinary approach to management.
Division of Cardiology, Children's National Medical Center, Washington, DC, USA.
Anita
A
Krishnan
Achintya
A
Moulick
Pranava
P
Sinha
Karen
K
Kuehl
Joshua
J
Kanter
Michael
M
Slack
Jonathan
J
Kaltman
Marco
M
Mercader
Jeffrey P
JP
Moak
D000328:Adult; D001201:Ascites / Q000209:etiology* / Q000628:therapy*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000628:therapy*; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016896:Treatment Outcome; D014264:Tricuspid Valve Stenosis / Q000209:etiology* / Q000628:therapy*