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High traffic congestion in right atrium.

S Mehrotra1, Bhupesh Kumar2, R Vijayvergiya3

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Summary

Pacemaker leads can cause long-term venous fibrosis and tricuspid stenosis, leading to heart failure. Surgical intervention, including lead removal and valve replacement, successfully restored function in a patient 33 years post-implantation.

Keywords:
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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Device Complications

Background:

  • Long-term implantation of cardiac electronic devices, such as pacemakers, can lead to delayed complications.
  • Venous fibrosis and subsequent valvular stenosis are potential, though uncommon, sequelae of indwelling pacemaker leads.

Observation:

  • A 62-year-old female patient presented with symptoms of heart failure, including limb swelling.
  • The patient had a history of pacemaker implantation 33 years prior.
  • Clinical examination revealed severe tricuspid stenosis attributed to lead-induced venous fibrosis.

Findings:

  • Surgical exploration confirmed significant venous fibrosis caused by the pacemaker leads.
  • The patient underwent successful surgical removal of all leads.
  • Tricuspid valve replacement was performed under cardiopulmonary bypass.

Implications:

  • This case highlights the potential for late-onset, severe complications from pacemaker leads, emphasizing the need for long-term monitoring.
  • Prompt diagnosis and surgical management can effectively treat lead-induced venous fibrosis and tricuspid stenosis.
  • Restoration of normal functional status and cardiac function is achievable even decades after initial implantation.