P884Value of transthoracic and transesophageal echocardiography in the diagnosis of tricuspid papillary muscle damage after transvenous leads extraction.


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Abstract

Introduction: Transvenous leads extraction (TLE) is an effective and safe procedure (1 % mortality vs. 10% in cardiac surgery). Postprocedural tricuspid papillary muscle damage with significant tricuspid regurgitation is a very rare complication of TLE intervension.Methods: We performed TLE in 758 patients, aged 5-91 (mean 64.7), with pacemaker (PM) and implantable cardioverter-defibrillator (ICD) systems. The most common indication for leads extraction were non-infective (52%: needless leads, venous occlusion and a new implantation necessity) and infective: local pocket infection and lead dependent infective endocarditis were less frequent (29,1% and 18,9%, respectively). The mortality rate was 0.3 %.TLE was performed using mechanical systems (various stylets and Byrd–Cook dilators), guided by pre- and postprocedural transthoracic and transesophageal echocardiography (TTE, TEE), (SONOS 5500,Andover,MA,Philips).Results: We found 6 patients (0.8%) with the postprocedural tricuspid papillary muscle damage and significant increase of tricuspid regurgitation (TR). The most probable cause of this damage during TLE was papillary muscle enfolding around the cardiac lead. In five patients we found complete papillary muscle rupture with ruptured head movement between right atrium and ventricle. Despite significant echocardiographic signs of TR only in one case hemodynamic deterioration appeared. In one patient we diagnosed incomplete tricuspid papillary muscle rupture with moderate TR which was asymptomatic.Conclusions: 1. Tricuspid papillary muscle rupture is a very rare complication (0,6%) of TLE procedure.2. TTE and TEE are excellent methods for this diagnosis.3. The preprocedural and postprocedural TTE and TEE are very important for comparison purposes.4. Despite the echocardiographic signs of significant tricuspid regurgitation hemodynamic deterioration is very rare.

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