A 32-year-old woman was diagnosed at the age of 8 years with a third degree atrioventricular block for which a DDD pacemaker was implanted. She now presented with exertional fatigue and dyspnoea because of a pacemaker lead-induced isolated tricuspid valve stenosis (mean gradient was 4 mm Hg at rest and 19 mm Hg during exercise, measured valve area using planimetry was 1.2 cm²) (Figure 1A). She was successfully treated with balloon valvotomy of the tricuspid valve using a 30 mm Inoue balloon (Toray industries Inc.) (Figure 1B) after which the tricuspid valve area augmented from 1.2 to 2.4 cm² (mean resting transvalvular gradient of 2 mm Hg at rest and 6 mm Hg during exercise) with only a mild tricuspid regurgitation (Figure 1C). The patient mentioned a dramatic symptomatic improvement during the weeks after the procedure. The most probable pathophysiological mechanism of this pacemaker lead-induced tricuspid stenosis is repeated whiplash injury by the lead leading to severe scarring of the valve with subsequent stenosis. To our knowledge, this is only the third case described of successful percutaneous balloon valvotomy for pacemaker lead-induced tricuspid stenosis.1 ,2 Most reported cases are treated surgically or conservatively.

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Figure 1

(A) 3D transthoracic planimetry before intervention (tricuspid valve (TV)). (B) A snapshot of the procedure (1, 2: permanent right atrial and right ventricular pacemaker leads; pace: temporary pacing lead; TEE: transoesophageal echo probe; ICE: intracardiac echo probe; *: fully inflated Inoue balloon). (C) 3D transoesophageal planimetry after intervention.