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Massive tricuspid regurgitation due to pacemaker-lead puncture of the tricuspid valve: successful diagnosis by 3-dimensional echocardiography. 2014

Rina Tamai, and Tomoya Hara, and Hirotsugu Yamada, and Susumu Nishio, and Mika Bando, and Junko Hotchi, and Shuji Hayashi, and Toshiyuki Niki, and Tetsuya Kitagawa, and Masataka Sata
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.

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.

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