Tailored Repair of Severe Tricuspid Regurgitation Due to Pacemaker Lead

A 64-year-old male was referred to the authors’ institution for severe symptomatic TR. The transthoracic echo confirmed severe TR with dilated annulus and the transesophageal echo showed mechanical interference with the posterior TV leaflet mobility and coaptation. Intraoperatively, a fibrotic response causing encapsulation of the lead on the posterior TV leaflet was noted and subsequently resected. Due to the anatomic condition of the TV, it was not possible to secure the lead in the anteroposterior or posteroseptal commissure without interfering with the valve closure, so the authors decided to secure the lead to the tricuspid annulus at the level of the posterior leaflet. The leaflet was longitudinally divided and the lead was secured to the tricuspid annulus and to the RV free wall with a single 3/0 prolene suture. The posterior TV leaflet was then reconstructed by means of interrupted 4/0 prolene suture using autologous pericardium to reinforce the suture. A 32 mm ring was then implanted in the standard way. The postoperative transesophageal echo showed a good result with no residual TR. In conclusion, in the case of TR caused by mechanical interference of the CIED lead, a bespoke repair aiming to avoid recurrence of mechanical interference is mandatory.