Tricuspid Insufficiency Caused by a Ventricular Pacemaker Lead Implanted 23 Years Previously

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 82; no. 3; pp. 520 - 524
• Main Authors: OKANO, Takahisa, FUJIWARA, Katsuji, YAKU, Hitoshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2021
• Subjects: pacemaker lead; tricuspid insufficiency; tricuspid valve replacement
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.82.520

A 72-year-old man underwent DDD pacemaker implantation via the subclavian vein. Several years previously he had noticed fatigability and exertional dyspnea, and these now worsened. Echocardiography showed interference by the ventricular lead with the posterior cusp of the tricuspid valve, tricuspid ring dilatation, right ventricular enlargement, and grade IV mitral regurgitation. Severe tricuspid insufficiency due to a ventricular pacemaker lead implanted 23 years previously was diagnosed. Intraoperatively, the ventricular lead was found to have severe adhesions to the posterior cusp of the tricuspid valve and the posterior papillary muscle, greatly restricting the range of motion of the valve. The valve was severely deformed, and valvuloplasty was considered not feasible. Sharp dissection was carried out so as not to damage the lead, and it was performed without cutting the lead during tricuspid valve replacement by moving it to the commissure between the anterior and septal cusps and fixing it outside the artificial valve suture ring. Because patients with no preoperative hepatic congestion or hepatic dysfunction and whose left heart function is maintained should have a good prognosis, it is important to conduct follow-up examinations with regular echocardiography and to perform surgery before it is too late and the patient's condition becomes severe.