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Pacing lead extraction in the management of tricuspid regurgitation: a case report.

Authors :
Khor, Lynn
Madan, Kedar
Lee, Choon Huat
Ng, Martin K C
Source :
European Heart Journal Case Reports; Jul2022, Vol. 6 Issue 7, p1-6, 6p
Publication Year :
2022

Abstract

Background Patients with a cardiac implantable electronic device (CIED)-induced tricuspid regurgitation (TR) have an increased mortality and morbidity. However, the impact of CIED-lead extraction and its indications are not well-defined. Case summary A 69-year-old woman presented with recurrent hospital admissions for right heart failure refractory to medical therapy, on the background of a single-chamber permanent pacemaker (Biotronik) implanted 6 years ago for tachycardia–bradycardia syndrome. Transoesophageal echocardiography identified severe TR which was predominantly CIED-induced from a lead impingement of the posterior tricuspid valve (TV) leaflet preventing adequate leaflet coaptation. This had progressed to cause a degree of secondary functional TR. The patient underwent pacing lead extraction followed by epicardial lead placement via minithoracotomy, with significant symptomatic and echographic improvement of TR. Discussion CIED-induced TR from a lead impingement of TV leaflets carries the highest risk of TR and its consequences. This case illustrates the significance of the relationship between CIED-leads and the TV, which impacts management strategy. We recommend a mechanistic approach and incorporating CIED-lead interaction with the TV apparatus as the underlying principle in developing future management guidelines for CIED-induced TR. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
25142119
Volume :
6
Issue :
7
Database :
Complementary Index
Journal :
European Heart Journal Case Reports
Publication Type :
Academic Journal
Accession number :
158395258
Full Text :
https://doi.org/10.1093/ehjcr/ytac170