Pulmonary Hypertension Unit, Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
Pulmonary Hypertension Unit, Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
BMJ Case Rep. 2020 May 19;13(5):e234549. doi: 10.1136/bcr-2020-234549.
We report the case of a 57-year-old male patient with prior syncope associated with sustained ventricular tachycardia in the setting of Brugada syndrome, who was submitted to implantation of a cardioverter defibrillator for secondary prevention. During follow-up, he presented a significant increase in lead impedance, and a transthoracic echocardiogram showed a mass attached to the lead. He was started on oral anticoagulation after infective endocarditis was excluded but nevertheless suffered repeated episodes of pulmonary embolism that led to severe chronic thromboembolic pulmonary hypertension. After heart team discussion, he was referred to pulmonary endarterectomy and replacement of the implantable cardioverter defibrillator with a subcutaneous device. This led to significant improvement of functional class and normalisation of pulmonary haemodynamics. More recently, he suffered syncope in the setting of ventricular fibrillation with appropriate shocks and was started on quinidine without further recurrence of arrhythmic episodes.
我们报告了一例 57 岁男性患者的病例，该患者既往因 Brugada 综合征伴持续性室性心动过速而晕厥，曾植入心脏转复除颤器进行二级预防。在随访过程中，患者的导联阻抗显著增加，经胸超声心动图显示导联上附着有一个肿块。在排除感染性心内膜炎后，患者开始接受口服抗凝治疗，但仍反复发生肺栓塞，导致严重的慢性血栓栓塞性肺动脉高压。经心脏团队讨论后，患者被转介至肺动脉内膜切除术，并将植入式心脏转复除颤器更换为皮下装置。这导致患者的功能分级显著改善，肺血流动力学正常化。最近，患者在心室颤动伴适当电击的情况下再次晕厥，开始使用奎尼丁治疗，此后未再发生心律失常事件。
