Tarui Tatsuya, Ikeda Masahiro, Miyazu Katsuyuki
Department of Thoracic and Cardiovascular Surgery, Toyama Red Cross Hospital, Toyama, Japan.
Kyobu Geka. 2012 Sep;65(10):918-21.
We performed infected implantable cardioverter-defibrillator lead extraction under deep hypothermic circulatory arrest in a 58-year-old man. Venogram during the implantation of the lead had revealed complete obstruction of the innominate vein. Preoperative trans-esophageal ecocardiogram revealed intracardiac vegetation with a diameter of 20×13 mm. Because of advanced adhesion and large vegetation, we performed lead extraction under cardiopulmonary bypass. The leads were adherent to the wall of the superior vena cava( SVC) and the innominate vein and could not be extracted. So we converted to deep hypothermic circulatory arrest. We performed venotomy in the SVC and the innominate vein to achieve complete visualization. The leads were extracted under direct vision. Postoperative course was uneventful without recurrence. Extraction of implantable devices is highly recommended when infection occurs. When adhesion of the lead is suspected, safe extraction can be performed by venotomy of the innominate vein under deep hypothermic circulatory arrest.
我们在一名58岁男性患者中，于深低温循环停搏下进行了感染性植入式心律转复除颤器导线拔除术。导线植入期间的静脉造影显示无名静脉完全阻塞。术前经食管超声心动图显示心内有直径为20×13 mm的赘生物。由于粘连严重且赘生物较大，我们在体外循环下进行导线拔除。导线粘连在上腔静脉（SVC）和无名静脉壁上，无法拔除。于是我们转为深低温循环停搏。我们在上腔静脉和无名静脉进行静脉切开以实现完全可视化。在直视下拔除导线。术后病程顺利，无复发。当发生感染时，强烈建议拔除植入装置。当怀疑导线粘连时，可在深低温循环停搏下通过无名静脉切开进行安全拔除。
