Severe Tricuspid Regurgitation With Giant C-V Waves After Pacer Implantation

A 79-year-old man underwent atrial flutter ablation and placement of biventricular pacer for intermittent complete heart block. His medical history is significant for Ehlers-Danlos syndrome and associated valvular heart disease, status post–aortic valve replacement with a bioprosthetic valve 2 years earlier. A transthoracic echocardiogram (TTE) 2 months before the procedure showed a bioprosthesis with moderate valvular stenosis, mild mitral regurgitation without prolapse, and mild tricuspid regurgitation (TR) without prolapse. His atria were dilated, and left ventricular function was normal. During the TTE, the patient was in normal sinus rhythm; the right ventricular inflow view of the tricuspid valve is shown in Movies I and II in the online-only Data Supplement. Maximum TR velocity by using continuous-wave Doppler was 2.7 m/s (Figure 1). The ablation procedure pacer implantation went well without noted complications.Figure 1. Continuous-wave Doppler waveforms of mild TR, with maximum TR velocity of ≈2.7 m/s. TR indicates tricuspid regurgitation.While shaving in the days following the procedure, the patient noticed a …