Beyond the Wires: A Case of Leadless Pacemaker–Mediated Tricuspid Regurgitation

Figures

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  Figure 1. Transthoracic echocardiogram after lead extraction and prior to LP insertion showing mild to moderate TR in an apical four-chamber view.

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  Figure 2. Transthoracic echocardiogram after LP insertion showing severe TR on a focused RV apical view.

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  Figure 3. Transthoracic echocardiogram after LP insertion showing severe TR on an RV inflow view.

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  Figure 4. Transesophageal deep esophageal RV focused view showing a broad tricuspid regurgitant jet.

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  Figure 5. Biplane imaging from a deep esophageal view showing the severe TR.

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  Figure 6. Continuous-wave Doppler of the TV showing a very dense profile and early peaking regurgitant jet consistent with severe TR.

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  Figure 7. Transesophageal echocardiogram in deep esophageal view demonstrating tethering of the TV leaflets with malcoaptation (red arrow).

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  Figure 8. Transesophageal echocardiogram with biplane imaging across the TV (RV inflow-outflow view at 45°) from a deep esophageal view showing the LP in the RV apex (yellow arrow). The LP is shown to be interacting with the subvalvular apparatus, with consequent papillary muscle and chordae tendinae restriction; leaflet tethering of the septal leaflet is shown by the red arrow, and leaflet tethering of the anterior leaflet is shown by the green arrow.

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  Figure 9. From left to right, image 1 shows no evident systolic flow reversal in the hepatic veins prior to LP implant; images 2 and 3 shows systolic reversal after LP implant on subsequent transthoracic echocardiograms done in 2019 and 2021, respectively.