Massive Tricuspid Regurgitation After Implantable Cardioverter Defibrillator Lead Extraction

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Massive primary tricuspid regurgitation due to fibrotic remnants ('ghost material') after transvenous lead extraction (n=1). Intervention: Surgical beating-heart tricuspid valve replacement with 27-mm Edwards Mitris bioprosthesis. Primary outcome: Resolution of massive tricuspid regurgitation and symptom improvement.

Q: What does this research mean for the field?

Residual fibrotic 'ghost material' following transvenous lead extraction can adhere to tricuspid valve apparatus and cause progressive, massive tricuspid regurgitation even decades after the procedure. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sarah Atighetchi; Fabien Praz; Fabian Noti; David Reineke; C. Chong-Nguyen

doi:10.1016/j.jaccas.2025.105292

October 1, 2025JACC Case ReportsOpen Access

Massive Tricuspid Regurgitation After Implantable Cardioverter Defibrillator Lead Extraction

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Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY

Why the study?

Fibrotic remnants after transvenous lead extraction, known as ghost material, can impair tricuspid valve function and cause progressive tricuspid regurgitation.

Key Points

To describe a rare case of massive tricuspid regurgitation caused by residual fibrotic tissue after transvenous lead extraction.
Clinical evaluation of a 64-year-old woman presenting with progressive dyspnea and fatigue 18 years after transvenous lead extraction.
Multimodality diagnostic assessment using electrocardiography, invasive coronary angiography, and transthoracic and transesophageal echocardiography.
Surgical intervention consisting of resternotomy and beating-heart tricuspid valve replacement using a 27-mm bioprosthesis.
Echocardiography showed massive primary tricuspid regurgitation with an effective regurgitant orifice area of 72 mm², vena contracta of 16 mm, and a flail-like retracted posterior leaflet.
Intraoperative inspection confirmed fibrotic remnants ('ghost material') fused to the posterior leaflet and lateral right atrial wall, suspending the leaflet into the atrium.
Tricuspid valve replacement restored competence, yielding a normal bioprosthetic mean gradient of 3 mm Hg at 3-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 64-year-old woman with massive primary tricuspid regurgitation caused by fibrotic 'ghost material' 18 years after ICD lead extraction, followed for 3 months post-surgical valve replacement.

I

Intervention

Surgical reoperation via median resternotomy with beating-heart tricuspid valve replacement using a 27-mm Edwards Mitris Resilia bioprosthesis

O

Outcome

Symptom improvement (dyspnea) and prosthetic valve function (mean gradient 3 mm Hg without paravalvular leakage) at 3-month transthoracic echocardiography follow-uphard clinical

Highlights that residual fibrotic 'ghost material' after transvenous lead extraction can adhere to the tricuspid valve apparatus and cause progressive, massive tricuspid regurgitation nearly two decades later, necessitating long-term echocardiographic follow-up.

Limitations

Single-patient case report
Histological processing of the extracted remnant material was not performed
Histological processing of the extracted fibrotic 'ghost material' was not performed

Implication

May prompt evaluation for ghost material in unexplained late TR after extraction; leaves open optimal surveillance protocols.

Abstract

BACKGROUND: Moderate tricuspid regurgitation (TR) is seen as pathological and can result from atrial or ventricular dilatation or interaction with device leads. Rarely, fibrotic remnants after transvenous lead extraction (TLE), referred to as "ghost material", can impair tricuspid valve function. CASE SUMMARY: A 64-year-old woman presented with dyspnea and fatigue. Echocardiography revealed massive primary TR, with a flail-like appearance of the posterior leaflet caused by a linear mobile structure retracting the leaflet. During surgery, the structure was identified as remnant fibrotic material of previous TLE, causing progressive massive TR in the course of 20 years. DISCUSSION: After TLE, residual fibrotic remnants, referred to as "ghost material", when attached to the valve apparatus can lead to progressive TR, even after many years. TAKE-HOME MESSAGE: Long-term outpatient follow-up is essential after TLE, as TR may progress and "ghost material" may even further induce fibrosis on the valve apparatus.

Discussion

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Cite This Study

Atighetchi et al. (2025) conducted a case report in Massive primary tricuspid regurgitation due to fibrotic remnants ('ghost material') after transvenous lead extraction (n=1). Surgical beating-heart tricuspid valve replacement with 27-mm Edwards Mitris bioprosthesis was evaluated on Resolution of massive tricuspid regurgitation and symptom improvement.

synapsesocial.com/papers/6aaf587f3a1726cc7f399130 https://doi.org/10.1016/j.jaccas.2025.105292

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Massive Tricuspid Regurgitation After Implantable Cardioverter Defibrillator Lead Extraction

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Massive Tricuspid Regurgitation After Implantable Cardioverter Defibrillator Lead Extraction

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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