Management of iatrogenic atrial perforation caused by pacemaker electrodes: a case report.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Graziano Fiorillo, Seyedali Ghazihosseini, Simone Agizza, Francesco Lanza, Simona Piccirillo, Giuseppe Gargiulo, Paola Gargiulo, Giovanni Battista Pinna, Emanuele Pilato, Carlo De Rosa, Carmine Morisco, Giovanni Esposito
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引用次数: 0

Abstract

Background: The complications associated with cardiac device implants ranges between 5.3% and 14.3%. Cardiac perforation due to "leads" represent a very rare complication of cardiac device implantation, ranging between 0.3% and 0.7%. Clinically, they can manifest different, nonspecific symptoms; hence, the diagnosis may not be immediate.

Case presentation: Our clinical case describes the successful treatment of cardiac tamponade occurring in a Caucasian 79-year-old man following a pacemaker implantation. Two days after the procedure, the patient reported an episode of nonspecific chest pain associated with syncope. The echocardiogram performed revealed a pericardial effusion in the apical area, along the right chambers, with a thickness of 7 mm, not hemodynamically significant. A chest computed tomography scan with contrast showed hemopericardium (maximum thickness of 11 mm), caused by an atrial perforation. A few hours later, the patient experienced hemodynamic instability. For this reason, an urgent sternotomy was performed with drainage of a significant hemopericardial effusion, revealing a perforation of the upper free wall of the right atrium with pericardial injury caused by the retractable screw lead. The perforation site was sutured and the sternal wound was closed. The patient was discharged after 4 days without further complications. At the control visit, scheduled 30 days after the hospital discharge, the patient was in good conditions.

Conclusions: Although the atrial perforations from leads are very rare complications of pacemaker implantation procedures, they are potentially lethal. In conclusion, this clinical case highlights the need, before hospital discharge, of an accurate screening for evaluation the pericardial effusion in patients that undergo to the cardiac implantable electronic devices.

起搏器电极引起的先天性心房穿孔的处理:病例报告。
背景:与心脏设备植入相关的并发症占 5.3% 到 14.3%。导线 "导致的心脏穿孔是一种非常罕见的心脏设备植入并发症,占 0.3% 到 0.7%。在临床上,它们可以表现出不同的非特异性症状,因此可能无法立即确诊:我们的临床病例描述了一名 79 岁的白种男子在植入心脏起搏器后发生心脏填塞的成功治疗。术后两天,患者报告出现非特异性胸痛,并伴有晕厥。超声心动图显示心尖区沿右心腔有心包积液,厚度为 7 毫米,对血流动力学无影响。造影剂胸部计算机断层扫描显示,血心包(最大厚度为 11 毫米)由心房穿孔引起。几小时后,患者出现血流动力学不稳定。为此,医生紧急进行了胸骨切开术,引流了大量血性心包积液,发现右心房上部游离壁穿孔,可伸缩螺钉导联导致心包损伤。对穿孔部位进行了缝合,并关闭了胸骨伤口。患者 4 天后出院,未再出现并发症。在出院 30 天后进行的对照检查中,患者情况良好:尽管导联造成的心房穿孔是起搏器植入手术中非常罕见的并发症,但却有可能致命。总之,该临床病例强调了在出院前对接受心脏植入式电子设备治疗的患者进行心包积液准确筛查评估的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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