title: Transvenous valve-in-valve replacement preserving the function of a transvalvular defibrillator lead.
abstract: Although feasibility and efficacy of percutaneous tricuspid valve-in-valve implantation have been established, a transtricuspid pacing or defibrillator lead might preclude this technique: lead damage can cause lead dysfunction resulting in inappropriate or inefficient pacing or shocks. In these cases, lead removal is thought to be the only option. We describe a patient who presented with rapid clinical deterioration due to tricuspid valve stenosis early after implantation of an internal defibrillator with a transvalvular shock-lead. A transvenous valve-in-valve implantation of the tricuspid valve was performed after protecting the defibrillator-lead with a custom-made covered stent. We describe the technical issues, the clinical outcome, and the evolution of lead function after implantation.
authors.affiliation: Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: De Meester
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000328:Adult; D000792:Angiography; D002405:Catheterization, Central Venous / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014264:Tricuspid Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: internal cardiac defibrillator; lead protection; percutaneous intervention; tricuspid valve