Cardiac pacing in a patient with mechanical tricuspid valve.

89 coaptation, the patient was scheduled for tricuspid valve annuloplasty with concurrent implantation of an epicardial ventricular lead and pacemaker. The operation was preceded by the transvenous extraction of the old ventricular lead. Due to advanced tricuspid valve lesions, a decision was made during surgery to perform artificial tricuspid valve implantation (Medtronic ATS 33 mm). Simultaneously, the pacing system with an epicardial ventricular lead (Medtronic sutureless unipolar screw-in pacing lead 5071) was implanted and the pacemaker was located in the abdominal wall. About 7 months later, increasing pacing thresholds and a decrease in the R-wave amplitude, as well as pacing abnormalities on elecrocardiography were observed (FIGURE 1B). Therefore, the patient was scheduled for transvenous pacemaker lead implantation through the coronary sinus. A left ventricular (LV) pacing lead (Medtronic Attain 4296) was implanted with good parameters. The postoperative period was complicated by infective endocarditis caused by methicillin -resistant Staphylococcus epidermidis, which required mitral valve replacement (Medtronic ATS 25M). Despite infective endocarditis on the mitral valve, we decided not to perform coronary sinus lead extraction, which was stable even after heart manipulations during cardiac surgery. About 5 months We report a case of a 71-year-old female patient who underwent the implantation of prosthetic mitral valve 25 years earlier (Medtronic Hall 29M, Medtronic, Minneapolis, United States) owing to severe mitral stenosis and regurgitation. Eleven years earlier, she underwent the implantation of a VVI type pacemaker because of paroxysmal second-degree atrioventricular block with syncope (FIGURE 1A). Recently, because of enormous tricuspid valve widening, which caused no valve leaflets