Oda Takeshi, Kono Takanori, Akaiwa Keiichi, Takahara Yasushi, Yasuoka Chie, Nakamura Katsuhiko
Department of Cardiovascular Surgery, Omura Municipal Hospital, 133-22 Kogashima-machi, Omura, Nagasaki 856-8561, Japan.
Department of Cardiology, Omura Municipal Hospital, 133-22 Kogashima-machi, Omura, Nagasaki 856-8561, Japan.
Case Rep Cardiol. 2017;2017:3242891. doi: 10.1155/2017/3242891. Epub 2017 Apr 6.
We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. The lead was cut in the pericardial cavity and extracted from the left subclavian wound together with the generator. The right ventricular perforation was sutured and a temporary pacing lead was placed on the right ventricular wall intraoperatively. Ten days after the surgery, a new pacemaker lead was placed in the ventricular septum via the right axillary vein. Right ventricular perforation is a rare complication after pacemaker implantation. Typically, it occurs at the time of implantation or within 24 hours after implantation. In the present case, the perforation of the right ventricle which needed urgent surgery occurred 4 days after implanting the pacing lead at the right ventricular apex. Great care should have been taken not to overlook this life-threatening complication even more than 24 hours after pacemaker implantation.
我们报告一例84岁女性患者，因病态窦房结综合征导致晕厥，在植入起搏器4天后出现右心室穿孔。正中胸骨切开术显示无心包积液，但起搏导线已穿透右心室和心包。打开胸膜后，可见导线尖端位于脏层胸膜。在心包腔内切断导线，并将其与发生器一起从左锁骨下伤口取出。术中对右心室穿孔进行缝合，并在右心室壁上放置临时起搏导线。术后10天，通过右腋静脉在室间隔置入一根新的起搏器导线。右心室穿孔是起搏器植入术后罕见的并发症。通常，它发生在植入时或植入后24小时内。在本病例中，在右心室尖部植入起搏导线4天后发生了需要紧急手术的右心室穿孔。即使在起搏器植入超过24小时后，也应格外小心，切勿忽视这种危及生命的并发症。
