Emergent Tricuspid Valve Transcatheter Edge-to-Edge Repair Following Papillary Muscle Rupture During Lead Extraction.

BACKGROUND

Transvenous lead extraction carries a small risk of vascular tears and tricuspid valve (TV) damage.

CASE SUMMARY: A 68-year-old woman with dilated cardiomyopathy and a primary prevention cardiac resynchronization therapy with a defibrillator presented with device infection and was referred for system extraction. During the procedure, she developed acute hemodynamic instability due to an anterior papillary muscle rupture, resulting in a flail anterior TV leaflet and severe tricuspid regurgitation. Emergent TV transcatheter edge-to-edge repair was performed successfully within 48 hours.

DISCUSSION: This is the first reported case of flail TV leaflet secondary to papillary muscle rupture during transvenous lead extraction, managed successfully with emergent transcatheter edge-to-edge repair. This case highlights the critical role of percutaneous intervention in the management of iatrogenic TV injury.

TAKE-HOME MESSAGES: TV injury is a rare but life-threatening complication of lead extraction. Percutaneous valve repair is a viable option for critically ill or inoperable patients.