Implantation of right ventricular endocardial pacing lead via paravalvular leak and subsequent paravalvular leak closure in a patient with mechanical tricuspid valve

Figures

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  Figure 1. Dynamic electrocardiogram and transthoracic echocardiogram before the procedure. A: Repeated cardiac pauses were recorded by 24-hour Holter monitoring. B: An unusual suture position of prosthetic tricuspid sewing ring with the posterior portion attached to the ostium of the coronary sinus (CS), and CS ostium on the ventricular side of mechanical tricuspid valve (TV). C: A tricuspid paravalvular defect (arrow) and moderate-to-severe regurgitation with the area of regurgitant color flow approximately 2.3 cm2 in subxiphoid 4-chamber view. RA = right atrium; RV = right ventricle.

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  Figure 2. Fluoroscopic imaging records during the procedure. A: Under anterior posterior fluoroscopic view, angiographic catheter and angiographic guide wires were used to explore paravalvular leak and establish the access from the right subclavian vein to the pulmonary artery. B: Two pacing leads (arrows) were screwed into the interventricular septum under the right anterior oblique (RAO) 30° fluoroscopic view. C: A 20 mm vascular plug (arrow) was positioned and deployed in the paravalvular defect. D: Imaging record at the end of the procedure. MV = mitral valve; TV = tricuspid valve.

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  Figure 3. Follow-up images. A: Postprocedure, the pacing electrocardiograms of the 2 leads (ventricular pacing and atrial pacing) were recorded. B, C: At 3-month follow-up, chest radiography showed satisfactory tension and no displacement of the 2 pacing leads. Transthoracic echocardiogram demonstrated only trivial paravalvular regurgitation. D: At 1-year follow-up, chest electrocardiogram at local hospital showed similar tension and position of the 2 pacing leads as before.