Silka M J, Rice M J
University Arrhythmia Service, Oregon Health Sciences University, Portland 97201.
Pacing Clin Electrophysiol. 1991 Apr;14(4 Pt 1):499-503. doi: 10.1111/j.1540-8159.1991.tb02820.x.
A young patient, who experienced a cerebral embolic event 30 days after transvenous pacemaker lead placement, is reported. This patient had previously been paced with an epicardial lead without evidence of right to left intracardiac shunt. However, hemodynamic evaluation post-embolism demonstrated a marked temporal disparity of the pulmonary and systemic ventricles. This phasic divergence resulted in a brief reversal of right and left ventricular pressure ratios, and a paradoxic intracardiac shunt at a small ventricular septal defect. The potential for similar events in the presence of any defect of the atrial or ventricular septum mandates caution in the use of transvenous pacemaker leads in such patients.
报告了一名年轻患者，其在经静脉起搏器导线置入30天后发生了脑栓塞事件。该患者此前使用心外膜导线起搏，未发现心内右向左分流的证据。然而，栓塞后的血流动力学评估显示肺心室和体心室存在明显的时间差异。这种阶段性差异导致右心室和左心室压力比值短暂逆转，并在小室间隔缺损处出现反常的心内分流。在存在房间隔或室间隔任何缺损的情况下，发生类似事件的可能性要求对此类患者使用经静脉起搏器导线时要谨慎。
