PMC9694373_01
Apical 4 chamber view on transthoracic echocardiogram showing pacemaker wire impinging and restricting tricuspid valve leaflet movement. White arrows show path of pacemaker wire. Yellow arrows show tricuspid valve leaflet. RV: right ventricle; LV: left ventricle; RA: right atrium; LA: left atrium. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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ABG on room air showed PH 7.41, pCO2 30 mmHg, pO2 66 mmHg, and the pO2 only improved to 155 mmHg on 100% FiO2 suggesting a large right to left shunt. A bubble contrast echocardiogram demonstrated left ventricular ejection fraction of 41-49%, moderate tricuspid valve regurgitation with restricted leaflet motion secondary to impingement by a pacemaker wire (Fig. 1) and a right to left shunt at the level of atria (Fig. 2).