Nakagawa Eiichiro, Abe Yukio, Komatsu Ryushi, Naruko Takahiko, Itoh Akira
Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
Department of Cardiology, HITO Hospital, 788-1 Kamibun-cho, Shikokuchuo City, Ehime Prefecture 799-0121, Japan.
J Arrhythm. 2015 Oct;31(5):313-5. doi: 10.1016/j.joa.2015.01.002. Epub 2015 Mar 16.
Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.
心腔穿孔导致的心脏压塞是起搏器植入相对罕见的并发症。我们报告首例与旋入式心房起搏导线植入相关的右冠状动脉穿孔病例,表现为危及生命的心脏压塞。我们报告一名72岁女性病例,该患者患有完全性房室传导阻滞且劳力性呼吸困难。植入了永久性起搏器,将美敦力双极主动固定导线置于右心耳和右心室基底间隔,过程顺利。术后约3.5小时,患者诉恶心,收缩压降至60 mmHg以下。超声心动图显示大量心包积液。由于心包穿刺效果持续不到一小时,患者接受了开胸手术。在排出大量心包积血后,可见鲜红色血液从右冠状动脉涌出,右冠状动脉位于右心耳的对侧,观察到一小部分螺钉尖端穿透心房壁。使用自体心包加固的7-0普理灵褥式缝线修复右冠状动脉穿孔。右冠状动脉穿孔是一种潜在并发症,应作为起搏器植入后心脏压塞鉴别诊断的一部分。