Tokunaga Chiho, Enomoto Yoshiharu, Sato Fujio, Kanemoto Shinya, Matsushita Shonosuke, Hiramatsu Yuji, Aonuma Kazutaka, Sakakibara Yuzuru
Department of Cardiovascular Surgery and Cardiology, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-7565, Japan.
J Artif Organs. 2012 Mar;15(1):94-8. doi: 10.1007/s10047-011-0610-8. Epub 2011 Sep 23.
With the growing number of cardiac pacemakers and internal cardioverter defibrillator implantations, problems with endocardial lead infection have been increasing. The newly developed Excimer Laser Sheath Lead Extraction System has been recognized as being highly useful for removing chronic infected leads. However, serious bleeding complications are a concern when this system is used. Here we report our experience with a 67-year-old man who was diagnosed with pacemaker endocarditis. Initially, lead removal was attempted using the Excimer Laser Sheath Extraction System, though this was abandoned because of severe adhesion of the leads and the junction of the supra vena cava (SVC) with the right atrium. Surgical removal of the leads was performed without using cardiopulmonary bypass and the leads were removed without any complications. During surgery, we found there was a silent perforation of the innominate vein brought about by the Excimer Laser Sheath System. Also, the junction of the SVC with the right atrium was thought to be an area potentially at high risk of perforation, because of a lack of surrounding tissue. It is our opinion that those who carry out procedures with the Excimer Laser Sheath System should understand the potential risk of perforation based on cardiac anatomy and should be prepared for lethal bleeding complications. Also, for emergent situations, we believe that close backup by a cardiovascular surgical team should be considered essential for performing the Excimer Laser Sheath Lead Extraction safely.
随着心脏起搏器和植入式心脏复律除颤器植入数量的不断增加，心内膜导线感染问题也日益增多。新开发的准分子激光鞘导线拔除系统已被认为在移除慢性感染导线方面非常有用。然而，使用该系统时严重出血并发症令人担忧。在此，我们报告一名67岁男性起搏器心内膜炎患者的治疗经验。最初，尝试使用准分子激光鞘拔除系统移除导线，但由于导线与上腔静脉（SVC）和右心房交界处严重粘连而放弃。在未使用体外循环的情况下进行了导线的手术移除，且导线移除过程未出现任何并发症。手术过程中，我们发现准分子激光鞘系统导致无名静脉出现隐匿性穿孔。此外，由于缺乏周围组织，SVC与右心房的交界处被认为是潜在的高穿孔风险区域。我们认为，使用准分子激光鞘系统进行操作的人员应基于心脏解剖结构了解潜在的穿孔风险，并应对致命性出血并发症做好准备。此外，对于紧急情况，我们认为心血管外科团队的密切支援对于安全进行准分子激光鞘导线拔除至关重要。
