植入式心脏复律除颤器发生器更换后双侧大量气胸：一例常见手术并发罕见事件的病例报告
Bilateral Large Pneumothoraxes Following Implantable Cardioverter-Defibrillator Generator Change: A Case Report of an Uncommon Event Complicating a Common Procedure.
作者信息
Bomb Ritin, Jha Sunil K
机构信息
Cardiologist at the University of Tennessee Health Science Center College of Medicine in Memphis.
Assistant Professor of Cardiovascular Diseases at the University of Tennessee Health Science Center in Memphis.
出版信息
Perm J. 2017;21:16-086. doi: 10.7812/TPP/16-086.
INTRODUCTION
A bilateral large spontaneous pneumothorax to our knowledge has never been reported after a device implantation. We report an unusual case of a patient developing spontaneous bilateral large pneumothoraxes after an implantable cardioverter-defibrillator generator and lead revision without evidence of any obvious traumatic cardiac injury.
CASE PRESENTATION
A 79-year-old white man was scheduled for implantable cardioverter-defibrillator generator change and addition of an atrial lead. Approximately one hour after the procedure, he suddenly went into respiratory distress with profuse sweating, and pallor with falling oxygen saturation and blood pressure. Chest x-ray showed bilateral large pneumothoraxes.
DISCUSSION
In our literature search, we found no reports of large bilateral pneumothorax in the absence of any traumatic cardiac or lung injury. Rupture of bilateral pleura during subclavian access or presence of pleuropleural communication or a right atrial microperforation could be possible causes.
引言
据我们所知，在植入装置后从未有过双侧大量自发性气胸的报道。我们报告一例不寻常的病例，一名患者在植入式心脏复律除颤器发生器和导线翻修后发生双侧大量自发性气胸，且无任何明显创伤性心脏损伤的证据。
病例介绍
一名79岁白人男性计划更换植入式心脏复律除颤器发生器并增加一根心房导线。术后约一小时，他突然出现呼吸窘迫，大汗淋漓，面色苍白，血氧饱和度和血压下降。胸部X线显示双侧大量气胸。
讨论
在我们的文献检索中，未发现无任何创伤性心脏或肺部损伤而出现双侧大量气胸的报道。锁骨下穿刺过程中双侧胸膜破裂、存在胸膜间交通或右心房微穿孔可能是其原因。
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