Aksu Tolga, Durukan Mine, Güray Umit, Colak Ayşe
Department of Cardiology, Türkiye Yüksek İhtisas Heart-Education and Research Hospital, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2011 Jul;39(5):403-6. doi: 10.5543/tkda.2011.01356.
A 74-year-old male patient presented with complaints of fatigue, fever, and worsening health status. He had a 34-month history of cardioverter-defibrillator (ICD) implantation due to ischemic cardiomyopathy. Transthoracic and transesophageal echocardiography showed a mobile mass, 24 x 11 mm in size, consistent with a vegetation attached to the right ventricular ICD lead. Surgical removal of the electrode was considered to be highly risky for the patient, thus percutaneous removal was decided. Due to adhesions, manual traction of the lead with a standard stylet was ineffective. Complete lead extraction was accomplished using the Evolution Mechanical Dilator Sheath, which is a new mechanical sheath with a stainless steel bladed tip. No complications occurred during or after the procedure. Following a histopathologic diagnosis of vegetation, the patient received a six-week antibiotic therapy, after which a new ICD was implanted on the contralateral side. To our knowledge, this case represents the largest lead vegetation extracted by this new device. Although its safety should be validated by increasing number of cases, it seems that its simple use would make this device a new interesting tool among the instruments available for lead extraction.
一名74岁男性患者主诉疲劳、发热且健康状况恶化。他因缺血性心肌病植入心脏复律除颤器（ICD）已有34个月病史。经胸和经食管超声心动图显示一个活动肿物，大小为24×11毫米，符合附着于右心室ICD导线的赘生物。手术取出电极对该患者而言风险极高，因此决定经皮取出。由于粘连，使用标准探针手动牵引导线无效。使用Evolution机械扩张鞘管完成了导线的完全取出，这是一种带有不锈钢刀片尖端的新型机械鞘管。手术过程中及术后均未发生并发症。在组织病理学诊断为赘生物后，患者接受了为期六周的抗生素治疗，之后在对侧植入了新的ICD。据我们所知，该病例是使用这种新设备取出的最大导线赘生物。尽管其安全性需通过增加病例数来验证，但似乎其使用简便将使该设备成为现有导线取出器械中一种新的有趣工具。
