[HSF] Pacer Lead Induced TR

Sun May 3 18:02:09 EDT 2009

These are all things that I have seen and done, but I get the sense that
sometimes we are trading 1 disease for potentially several - that might have
difficult or interesting management implications.  For example, I am dealing
now with infected epicardial pacing leads - 2 years post-op which has been a
real headache for the patient (and me also).

We have a very busy EP group here and without any evidence, I am not sure
long-term CS leads are a great idea and extracted leads can be hard enough
as it it- to pull them through outside of a valve cuff sounds like a
disaster in the making.

I am sure Tea will have some insightful comments on this.

-michael

On Sun, May 3, 2009 at 4:55 PM, Roberto Battellini <
robertobattellini at hotmail.com> wrote:

>
> Paravalvular leak???
>
> Roberto
>
> > From: prasannasimha at gmail.com
> > Date: Sun, 3 May 2009 22:27:35 +0530
> > Subject: Re: [HSF] Pacer Lead Induced TR
> > To: OpenHeart-L at lists.hsforum.com
> > CC:
> >
> > new tricuspid valve ? You dont put the lead through the new valve you put
> it
> > outside - between the sewing rim and the true annulus .
> > Prasanna
> >
> > On Sun, May 3, 2009 at 9:32 PM, Michael Firstenberg <msfirst at gmail.com
> >wrote:
> >
> > > How much TR would be left after putting a lead through a new TV?
> > > Not to mention the risks for lead infections?
> > >
> > > -michael
> > >
> > > On Sun, May 3, 2009 at 8:00 AM, <Hgrmd at aol.com> wrote:
> > >
> > > > Michael,
> > > > From the way your initial post read, I assume you were referring to
> > > > clinically important TR associated with permanent pacing leads. It is
> > > well
> > > > documented in the literature that moderate or worse TR adversely
> impacts
> > > > the 10
> > > > yr survival, similar to moderate or worse MR. I would rather leave a
> > > > patient with a bioprosthesis instead of severe TR.
> > > >
> > > > Hal
> > > >
> > > >
> > > > In a message dated 5/3/2009 4:23:33 A.M. Eastern Daylight Time,
> > > > msfirst at gmail.com writes:
> > > >
> > > > Hal,
> > > > Since you are trading one disease for another - i.e. replacing the TV
> > > with
> > > > a
> > > > tissue valve in a patient who already has/needs a pacer (and I have a
> > > low
> > > > threshold for epicardials myself) - do you have different criteria
> for
> > > > when
> > > > you would intervene on the valve in the first place - since you
> already
> > > > know
> > > > that having leads will produces some degree of TR. Does that change
> if
> > > > you
> > > > know that the annulus is normal?
> > > >
> > > > -michael
> > > >
> > > > On Sat, May 2, 2009 at 6:54 PM, <Hgrmd at aol.com> wrote:
> > > >
> > > > > Michael,
> > > > > It depends on what is producing the TR. Sometimes the lead actually
> > > > > perforates the leaflet. In that case, a triangular resection and
> > > > > subsequent
> > > > > autologous pericardial patch will take care of it. Other times, the
> > > > lead
> > > > > is
> > > > > holding back the leaflet (usually posterior or septal), producing
> the
> > > > TR.
> > > > > In those cases the lead should be shaved from the leaflet edge and
> > > > then
> > > > > forced into the corner of the postero-septal commissure. It is held
> > > > into
> > > > > place with a couple of sutures. If these measures don't work, then
> > > > > consider
> > > > > TVR (Mitral Magna is what I would use).
> > > > >
> > > > > Hal
> > > > >
> > > > >
> > > > > In a message dated 5/2/2009 12:15:38 P.M. Eastern Daylight Time,
> > > > > msfirst at gmail.com writes:
> > > > >
> > > > > With patients with mod/sev TR (normal or near normal annular sizes)
> > > > from
> > > > > distortion of the leaflets from chronic RV pacing leads - does
> anyone
> > > > have
> > > > > thoughts on "fixing" these? Or some other management insight?
> > > > >
> > > > >
> > > > > -michael
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> > Prasanna Simha M
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