Tricuspid valve stenosis related to subvalvular adhesion of pacemaker lead: a case report.

Endocardial pacemaker leads may cause tricuspid valve regurgitation, but only four cases of tricuspid stenosis without endocarditis have been reported. A 77-year-old woman had received three endocardial leads when aged 44, 57, and 72 years. One lead pushed up the septal leaflet of the tricuspid valve from below the valve, then adhered to the leaflet, and was positioned against the ventricular septum. Tricuspid valve stenosis and moderate regurgitation were separately detected by transthoracic echocardiography. The tricuspid valve orifice area was 0.93 cm2 at cardiac catheterization. An excessive loop of a ventricular lead, especially a subvalvular loop, can cause opening limitation of the tricuspid valve, and the entangling of the lead in the subvalvular structures can easily induce reactive fibrosis and adhesions.