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Case Report
Symptomatic pulmonary regurgitation secondary to redundant transvenous lead prolapse
1 Department of Medicine, Division of Cardiology/Electrophysiology, University of Southern California/Keck Medical Center of USC, Los Angeles, California 90033, USA
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Guillermo Andres Cortes
MD, Department of Medicine, Division of Cardiology/Electrophysiology, University of Southern California/Keck Medical Center of USC, Los Angeles, California 90033,
USA
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Article ID: 101121Z01GC2020
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Cortes GA, Doshi RN, Chang PM. Symptomatic pulmonary regurgitation secondary to redundant transvenous lead prolapse. Int J Case Rep Images 2020;11:101121Z01GC2020.ABSTRACT
Introduction: The use of cardiac implantable electronic devices (CIEDs) with transvenous leads (TVLs) in young patients continues to increase. Challenges persist, particularly related to TVLs complications. We present a unique case of redundant lead prolapse into the right ventricular outflow tract (RVOT) causing symptomatic pulmonary regurgitation (PR).
Case Report: A 23-year-old female with congenital heart block underwent initial transvenous (TV) pacemaker implant at age 9 years, followed by new lead implants at age 20 due to lead fracture. The original TVLs were abandoned. She developed progressive exercise intolerance and exertional dyspnea. Catheterization showed normal pulmonary pressures; exercise testing indicated worsening PR and limited LV functional increase. Imaging confirmed significant lead prolapse of the original right ventricular (RV) lead causing PR. Extraction with cardiac resynchronization therapy-pacemaker (CRT-P) upgrade was recommended. A superior/inferior extraction approach was employed for extraction of all TVLs with CRT-P implant using the retained venous access post-extraction. Post-implant imaging revealed appropriately positioned leads, normalization of left ventricular (LV) function, and trace tricuspid regurgitation (TR) and trace-mild PR.
Conclusion: This case highlights an unusual complication of excessive TVLs slack. Challenges remain with long-term TVLs management in young patients. Proactive lead management is recommended to ensure CIED benefit while reducing TVLs complications. When extraction is considered, a superior/inferior approach can afford tremendous versatility to maximize success.
Keywords: Congenital, Heart block, Pulmonary regurgitation, Slack, Transvenous lead
SUPPORTING INFORMATION
Author Contributions
Guillermo Andres Cortes - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rahul N Doshi - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Final approval of the version to be published
Philip M Chang - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Guillermo Andres Cortes et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
