Pecha Simon, Vogler Julia, Reichenspurner Hermann, Hakmi Samer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Interact Cardiovasc Thorac Surg. 2018 Feb 1;26(2):360-361. doi: 10.1093/icvts/ivx296.
Injuries to the superior vena cava (SVC) during transvenous lead extraction (TLE) procedures are a rare but life-threatening complication. The Bridge Occlusion Balloon (BOB) is specifically designed for temporary SVC occlusion in TLE procedures. We report the first case of a 27-year-old man using the BOB as a safety net in a high-risk TLE procedure. This patient, with a congenitally corrected transposition of the great arteries and a third-degree atrioventricular block, presented with 4 dysfunctional pacemaker leads, venous stenosis and the necessity for a new pacemaker system. The leads were implanted for 10 and 19 years. The BOB was placed with a radiopaque marker at the cavoatrial junction and was inflated with 46 ml of an 80/20 saline/contrast agent mixture. An angiography was performed to confirm SVC occlusion. With the deflated balloon in place, the TLE procedure with laser and mechanical sheaths was performed. Successful extraction of 2 dysfunctional leads, as well as venous recanalization, for the new right atrial and right ventricular lead implantation was achieved. We have shown the feasibility of using powered extraction sheaths with a deflated BOB in place. This allows for immediate balloon inflation, in case of an SVC perforation.
经静脉导线拔除（TLE）过程中对上腔静脉（SVC）的损伤是一种罕见但危及生命的并发症。桥接闭塞球囊（BOB）专为TLE过程中的临时SVC闭塞而设计。我们报告首例在高风险TLE手术中使用BOB作为安全保障的27岁男性病例。该患者患有先天性矫正型大动脉转位和三度房室传导阻滞，有4根功能失调的起搏器导线、静脉狭窄，且需要植入新的起搏器系统。这些导线已植入10年和19年。将带有不透射线标记的BOB置于腔房交界处，用46毫升80/20的生理盐水/造影剂混合物使其膨胀。进行血管造影以确认SVC闭塞。在球囊放气的情况下，使用激光和机械鞘管进行TLE手术。成功拔除2根功能失调的导线，并实现静脉再通，以便植入新的右心房和右心室导线。我们已证明在球囊放气的情况下使用动力拔除鞘管的可行性。这样在发生SVC穿孔时可立即使球囊膨胀。
