ABSTRACT
We report a case of percutaneous transluminal angioplasty (PTA) treatment for low cardiac output syndrome due to superior vena cava (SVC) stenosis with venous return anomaly. A 69-year-old man was referred to our hospital for surgical treatment of tricuspid valve infective endocarditis due to infected pacemaker leads, which had been implanted for sick sinus syndrome. Preoperative computed tomography indicated polysplenia syndrome-related absence of the hepatic segment of the inferior vena cava (IVC). Preoperative coronary angiography showed a 99% stenosis in the left anterior descending artery and a total occlusion in the right coronary artery. We therefore performed pacemaker system removal, tricuspid valve plasty, coronary artery bypass surgery, and a new pacemaker implantation (epicardial leads). However, over the postoperative course we noted low cardiac output syndrome due to SVC syndrome, which appeared to be aggravated by venous return anomaly from the patient's absent IVC hepatic segment. Eight days after the surgery we conducted PTA for SVC syndrome, which notably improved the patient's hemodynamics. The patient recovered and was transferred to a rehabilitation facility 34 days after the surgery.
ABSTRACT
Severe and permanent tricuspid regurgitation induced by pacemaker leads is rarely reported in the literature. The mechanism of pacemaker-induced tricuspid regurgitation has been identified, but its management has not been well established. Furthermore, debate still exists regarding the proper surgical approach. We present the case of a patient with severe tricuspid regurgitation induced by a pacemaker lead, accompanied by triple valve disease. The patient underwent double valve replacement and tricuspid valve repair without removal of the pre-existing pacemaker lead. The operation was successful and the surgical procedure is discussed in detail.
Subject(s)
Humans , Tricuspid Valve , Tricuspid Valve InsufficiencyABSTRACT
Transvenous pacemaker lead extraction (TLE) techniques for pacemaker lead infection have developed in recent years. Several minimally invasive methods for TLE have been devised, but fatal complications are not rare in these procedures. We present the case of a 26-year-old woman with Brugada syndrome referred to our hospital with wound infection, 3 years after implantation. She had the 2 infected leads completely removed with laser sheaths and underwent antibiotic therapy. On post operative day 8, pulsatile mass with thrilling was noted at the suprasternal notch. Enhanced CT examination revealed the fistula between the brachiocephalic artery and vein (AVF). Operation was scheduled to close the fistula. Early in the morning of the scheduled operation day, extensive bleeding from the ruptured mass on the suprasternal notch occurred and emergency operation was done to suture the bleeding point and ligate both side of the fistula of the brachiocephalic vein, using an occlusion balloon inserted into the brachiocephalic artery. The postoperative course was uneventful. AVF after TLE is a rare complication. Although the cardiac implantable electronic device can provide life-saving benefits, device-associated complications should be managed carefully.
ABSTRACT
Transvenous pacemaker leads may impair tricuspid valve coaptation, and is a well-known cause of tricuspid regurgitation (TR). The mechanism underlying TR may be the perforation or laceration of the valve leaflets, direct lead interference with the valve closure, or adhesion of scar tissue between the leads of the pacemaker and the valve leaflet. Recently, three-dimensional echocardiography has clarified the pathway of the pacing lead and its interference with the tricuspid valve, but surgical treatment is not conventionally performed in the early stages of TR because of the necessity of the pacing lead. Occasionally, patients with TR develop severe right-sided heart failure, and the operative mortality in such conditions is very high. Thus, it is important to study the relationship between transvenous leads and TR. Tricuspid valve surgery is usually performed after replacing the transvenous lead with an epicardial lead. However removal of the transvenous lead may cause injury to the right ventricle, and ventricular chronic stimulation thresholds with epicardial stimulation have been shown to be significantly higher than those with endocardial stimulation. We performed TR surgery in 5 patients without removing the transvenous leads. To avoid interference with the valve closure, we shifted the pacemaker leads to the commissure and fixed them to the annulus. All the patients underwent successful tricuspid valve repair or replacement, and the symptoms of right-sided heart failure improved after the operation. We concluded that this technique is a very simple, and feasible method for treatment of most patients with TR caused by pacing leads.
ABSTRACT
Objective: To report that screw-in type pacing leads can be removed by screw retraction even after a significant anchoring period. Patient: A 78-year-old woman who visited our hospital for skin erosion over a pacemaker that had been implanted 3 years previously and had migrated from the subclavicular area to the axilla. Methods: Culture revealed a local staphylococcus infection. We placed a new pacemaker system in the contralateral (right) side, removed the old one, inserted a straight type stylet into the leads, and turned the rotator counterclockwise. Results: An image monitor confirmed complete retraction of the ventricular lead screw and partial retraction of the atrial lead screw, and we were able to pull out both leads without any resistance. The patient was given antibiotics and discharged 2 days after the surgery. No wound infection was evident at a 3-month follow-up examination. Conclusion: When a screw-in type pacemaker with a retractor must be removed long after its implantation, screw retraction should be tried before resorting to a removal kit or open heart surgery.
ABSTRACT
A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan
Subject(s)
Aged , Humans , Actinobacillus , Aggregatibacter actinomycetemcomitans , Anti-Bacterial Agents , Bacteremia , Ceftriaxone , Chills , Ciprofloxacin , Dental Caries , Diagnosis, Oral , Fever , Inflammation , Technetium Tc 99m ExametazimeABSTRACT
A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan
Subject(s)
Aged , Humans , Actinobacillus , Aggregatibacter actinomycetemcomitans , Anti-Bacterial Agents , Bacteremia , Ceftriaxone , Chills , Ciprofloxacin , Dental Caries , Diagnosis, Oral , Fever , Inflammation , Technetium Tc 99m ExametazimeABSTRACT
The infected endocarditis related permanent pacemaker occurs rare and most of them occur at generator pocket but endocarditis related permanant pacemaker lead itself occurs very rarely. The rate of infection after pacemaker implantation is reported as 0.13-7% or 0.13-19.9% and mortality rate is up to 24-33%. Focal inflammation of generator pocket is easily detected but it is difficult to diagnose endocarditis related pacemaker lead and it has poor prognosis. Especially, early diagnosis is most important because endocarditis related pacemaker is fatal. Thirteen years ago, a womon was inserted the permanent pacemaker and then only generator was removed after one month. We report a case that we had removed the pacemaker lead by open thoracostomy and cardiopulmonary circulation to treat endocarditis related pacemaker lead.
Subject(s)
Early Diagnosis , Endocarditis , Inflammation , Mortality , Prognosis , ThoracostomyABSTRACT
Objective To follow up the patients with pacemaker, observe the condition of pacemaker lead, to explore the cause of lead dislocation, to find out and prevent its occurrence.Methods Summarizing the clinical data of 6 patients with pacemaker,7 pacemaker leads with 8 time dislocation,pacemaker 2 DDDR、2 DDD、2 VVI。 Results Four patients were punctured from right subclavian vein、one from left subclavian vein and one from right brachiocephalic vein; four leads were dislocation in atrium and one mildly dislocation; four leads dislocation in ventricle and two mildly dislocation; There were 3 old women with 4 leads and 5 times of dislocation. Conclusions