Figure 3.

Pacemaker lead-associated TR. Left image, 2D A4C view. An RV pacing lead can be seen crossing the TV (white arrow). Right image, TOE 3D live zoom image of the RA en face view of the TV. As the leaflets of the TV close in systole, the septal leaflet appears tethered and fixed to the pacing lead, with a large coaptation defect, with resultant severe TR. White dotted line, TV annulus; IAS, interatrial septum position; AV, aortic valve; A and S, anterior and septal TV leaflets.