[Pacemaker lead-induced tricuspid stenosis: a report of two cases]. / Estenose tricúspide induzida por eletrocateter de pacemaker: relato de 2 casos clínicos.

Tricuspid stenosis (TS) is an uncommon complication of transvenous ventricular pacemaker implantation, with few cases reported in the literature. The mechanisms described are obstruction of right ventricular inflow by tricuspid vegetations (endocarditis), multiple pacemaker leads and tricuspid valve (TV) fibrosis secondary to perforation or laceration of the TV leaflets, or adherence between redundant portions of the lead and valvular and subvalvular tissue. We report two cases of severe TS, with different etiologies and management: one caused by leaflet perforation, resolved surgically, and the other secondary to fusion between a loop of the pacemaker lead and the subvalvular apparatus, which was treated medically.

Transient left ventricular apical ballooning--characterization of an increasingly common new diagnostic entity. Another case report.

Transient left ventricular apical ballooning syndrome (ABS) is characterized by chest pain, electrocardiographic alterations mimicking acute myocardial infarction (MI), transient left ventricular apical dyskinesis and normal coronary angiogram. It usually has a favorable prognosis. We present the case of a 71-year-old female patient, with a history of respiratory infection, who was admitted to the emergency department with chest discomfort, electrocardiographic alterations suggesting anterolateral MI, and shock. The admission echocardiogram revealed apical dyskinesis and dilatation, basal hypercontractility and a left intraventricular gradient of 75.27 mmHg. Elevation of cardiac biomarkers was disproportionately low. Coronary angiography was normal and the echocardiographic abnormalities disappeared after the tenth day of hospitalization. We describe the diagnostic criteria and characteristics of ABS. It is more prevalent in post-menopausal women and has a recognized association with stress. Its incidence will probably rise with increasing awareness of this entity, aging populations, and wider access to echocardiography and cardiac catheterization.