Severe Tricuspid Stenosis Secondary to Permanent Pacemaker Lead

Tricuspid stenosis (TS) is a rare valvular abnormality and generally associated with mitral stenosis in cases of rheumatic heart disease. TS is now frequently being described in the setting of permanent pacemaker leads, either with or without the presence of infective endocarditis. We describe a case of a female with TS secondary to permanent pacemaker leads in the absence of infective endocarditis being managed during the pre-conception period. She initially had a balloon valvuloplasty done for moderate to severe TS and subsequently conceived and delivered without complications. However, upon being evaluated before her second pregnancy, she was again found to have severe TS. We hypothesize that the presence of permanent pacemaker lead contributed to the development of early restenosis after the first procedure. A repeat balloon valvuloplasty was unsuccessful and she ultimately underwent successful tricuspid valve replacement with no echocardiographic or clinical signs of restenosis years later. The options for management of TS secondary to permanent pacemaker lead include medical management, balloon valvuloplasty (with or without removal of pacemaker lead), or tricuspid valve replacement. Overall, there is a scarcity of data on long-term outcomes of either option making the management challenging.