Nakamoto Susumu, Oka Hiroshi, Zhang Zhiwei, Onoe Masahiko, Kaneda Toshio, Inoue Takehiro, Saga Toshihiko
Department of Cardiovascular Surgery, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan.
Surg Today. 2002;32(11):947-50. doi: 10.1007/s005950200190.
Cardiac leads that became infected, fail, or are otherwise problematic present difficulties in the management of patients. In this report, we assess our intravascular countertraction technique.
Between February 1990 and January 2001, 13 leads were removed from 11 patients using the intravascular countertraction technique. The reasons for lead extraction were pacemaker infection and lead dysfunction.
In two of these patients, the ventricular leads could not be completely removed. The complete success rate was 85% and the overall success rate was 92%. There were no serious complications such as cardiac rupture, vein injury, or death, and there were no clinical signs of pulmonary embolism. In one of the patients whose ventricular leads could not be removed completely, the ventricular lead was stretched from its previous round shape, but tricuspid valve regurgitation did not occur during the 3-year follow-up period. In the other patient, the distal electrode was left in the subclavian vein. However, this residual distal electrode did not migrate, and there were no clinical signs of any recurrence of infection.
The present study suggests that to remove leads successfully, the largest locking stylet that can be easily passed to the lead's tip through the coil lumen should be chosen in order to avoid valve injury, which can sometimes occur when a ventricular lead's locking stylet is left in the coil lumen.
感染、失效或存在其他问题的心脏导线给患者管理带来困难。在本报告中，我们评估了我们的血管内反向牵引技术。
在1990年2月至2001年1月期间，使用血管内反向牵引技术从11例患者身上取出了13根导线。导线拔除的原因是起搏器感染和导线功能障碍。
在这些患者中，有2例心室导线未能完全取出。完全成功率为85%，总成功率为92%。没有发生心脏破裂、静脉损伤或死亡等严重并发症，也没有肺栓塞的临床迹象。在1例心室导线未完全取出的患者中，心室导线从原来的圆形被拉长，但在3年随访期间未发生三尖瓣反流。在另一例患者中，远端电极留在锁骨下静脉。然而，这个残留的远端电极没有迁移，也没有感染复发的临床迹象。
本研究表明，为了成功取出导线，应选择能够轻松通过线圈腔到达导线尖端的最大锁定管芯，以避免心室导线锁定管芯留在线圈腔内时有时会发生的瓣膜损伤。
