Massive tricuspid regurgitation due to pacemaker-lead puncture of the tricuspid valve: successful diagnosis by 3-dimensional echocardiography.
An 83-year-old woman presented to our echocardiographic center with symptoms of right heart failure. A dual-chamber DDDR pacemaker had been implanted 9 years earlier. Two-dimensional echocardiography revealed right atrial and ventricular enlargement and massive tricuspid regurgitation with immobilization of the anterior leaflet of the tricuspid valve. Three-dimensional transesophageal echocardiography showed that the pacemaker lead had punctured the leaflet. These echocardiographic findings were confirmed during surgery. The pacemaker lead was transected and removed, and pericardial patch closure of the leaflet hole and tricuspid annuloplasty were performed. The mechanism of regurgitation was elucidated by real-time three-dimensional echocardiography, and surgical repair was straightforward.
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Rina
R
Tamai
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Tomoya
T
Hara
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan. yamadah@tokushima-u.ac.jp.|Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan. yamadah@tokushima-u.ac.jp.
Hirotsugu
H
Yamada
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Susumu
S
Nishio
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Mika
M
Bando
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Junko
J
Hotchi
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Shuji
S
Hayashi
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Toshiyuki
T
Niki
Department of Cardiovascular Surgery, Tokushima University Hospital, Tokushima, Japan.
Tetsuya
T
Kitagawa
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.|Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Masataka
M
Sata
3-Dimensional echocardiography; Pacemaker-lead puncture; Tricuspid regurgitation