Genesis of tricuspid regurgitation after permanent pacemaker implantation: two-dimensional and M-mode echocardiographic study

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  • KOBAYASHI Sayuki
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • HAYASHI Terumi
    Department of Cardiology, Saitamakenoh Hospital
  • MINAI Michiko
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • ZENRI Hiroko
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • ICHIHARA Michiko
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • HAYASHI Akiko
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • SAKAI Yoshihiko
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital
  • TAKAYANAGI Kan
    Department of Cardiology, Dokkyo Medical University, Koshigaya Hospital

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Other Title
  • ペースメーカリードによる三尖弁逆流の成因について ‐断層心エコー図，Mモードエコー図による検討‐

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Purpose: The purpose of this study is to clarify the genesis of TR due to right ventricular permanent pacemaker implantation (PPI). Subjects and Methods: We performed transthoracic echocardiography on 37 patients before and after PPI. No patients showed moderate or severe TR before PPI. After PPI, 29 patients showed no change of TR (N-group), and 8 patients developed moderate or severe TR (TR-group), as assessed by color Doppler echocardiography. We measured the insertion angle of the pacing leads between tricuspid valve orifices and the their anchored positions. In order to identify the anchor portion of the leads, we analyzed the sites of maximum size of the early systolic notch in the IVS that showed asynchrony due to electrical stimulation of pacing leads on M-mode echocardiograms using a line-scan recorder with a paper speed of 50 mm/sec. The mean follow-up period was 63 months. Results: 1. The insertion angle of pacing leads was significantly large in the TR group as compared with the N group (18±10 vs 0±5 degrees, p⟨0.0001). 2. The sites of maximum size of the notch were located at the basal or mid portion of the IVS in the TR group, whereas they were mostly located at the apical IVS in the N group. Conclusion: The genesis of TR after PPI was considered to be due to pacing leads crossing the tricuspid orifice obliquely, compressing the septal leaflets, and anchoring at a higher position of the IVS that disturbed coaptation of tricuspid valves.

Journal

  • Choonpa Igaku

    Choonpa Igaku 38 (2), 111-117, 2011

    The Japan Society of Ultrasonics in Medicine

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