Massive Tricuspid Regurgitation After Implantable Cardioverter Defibrillator Lead Extraction: A Late Complication From Ghost Material [case report].

Background Moderate tricuspid regurgitation (TR) is seen as pathological and can result from atrial or ventricular dilatation or interaction with device leads. Rarely, fibrotic remnants after transvenous lead extraction (TLE), referred to as "ghost material", can impair tricuspid valve function. Case Summary A 64-year-old woman presented with dyspnea and fatigue. Echocardiography revealed massive primary TR, with a flail-like appearance of the posterior leaflet caused by a linear mobile structure retracting the leaflet. During surgery, the structure was identified as remnant fibrotic material of previous TLE, causing progressive massive TR in the course of 20 years. Discussion After TLE, residual fibrotic remnants, referred to as "ghost material", when attached to the valve apparatus can lead to progressive TR, even after many years. Take-home Message Long-term outpatient follow-up is essential after TLE, as TR may progress and "ghost material" may even further induce fibrosis on the valve apparatus.