PMC6474773_01
(
A
) Posterioranterior view of the single chamber implantable cardioverter-defibrillator with abandoned left ventricular lead and correctly placed right ventricular lead. (
B
) Lateral chest view of the single chamber ICD. (
C
) 3D transoesophageal echocardiographic view demonstrating passage of misplaced left ventricular lead over patent atrial septal defect and retraction of the posterior mitral leaflet. (
D
) 2D transoesophageal echocardiographic view demonstrating mitral regurgitation by retraction of the posterior mitral leaflet with moderate/large jet extending up to the pulmonary veins. (
E
) Posterior-anterior view of the Spectranetics Tightrail 11 French with adhesiotomy of the left ventricular lead up to the right atrium after successful extraction of the right ventricular lead. (
F
) 2D transoesophageal echocardiographic view demonstrating similar mitral regurgitation by retraction and fibrosis of the posterior leaflet with moderate/large jet extending up to the pulmonary veins after lead extraction. 2D, two-dimensional; 3D, three-dimensional.
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Right branch bundle block and echocardiographic examination ultimately led to diagnosis of an inadvertent placement of the single coil ICD lead over a patent atrial septal defect and passage over the mitral valve, causing regurgitation due to retraction of the posterior leaflet ( Fig. 1A-D ; Videos 1 and 2 ). Tightrail 11-F); the option of laser photoablation was abandoned due to laser-energy-induced microbubble formation with increased emboli risk via the patent septal defect. This procedure was performed with cardiopulmonary bypass standby; adhesiotomy up to the cavity of the right atrium could be achieved with echocardiographic support to rule out effusions or pericardial tamponade ( Fig. 1E ). Lead extraction was successful, the retraction of the posterior leaflet after 12 years, however, was caused fibrosis and valve regurgitation remained ( Fig. 1F ).