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医源性微穿孔与出血性心包积液并发心脏压塞相关。

Iatrogenic Microperforation Linked to Hemorrhagic Pericardial Effusion Complicated by Cardiac Tamponade.

作者信息

Philip Arun

机构信息

Internal Medicine, Methodist Health System, Dallas, USA.

出版信息

Cureus. 2020 Jul 6;12(7):e9023. doi: 10.7759/cureus.9023.

DOI:10.7759/cureus.9023
PMID:32775103
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7405971/
Abstract

Pericardial effusions have a wide range of etiologies, including infection, inflammation, and malignancy. A complication of pericardial effusion is cardiac tamponade. In instances of cardiac tamponade, prompt echocardiography and stabilization are paramount in preventing mortality. Here, we report a case of iatrogenic microperforation of the right ventricle during a pacemaker lead adjustment causing a delayed pericardial effusion complicated by cardiac tamponade. Lead removal is recommended in cases of valvular endocarditis, pocket infection, thrombosis, or life-threatening dysrhythmias; however, there are no established guidelines in the setting of perforation. In this case, an emergent pericardiocentesis was performed due to cardiac tamponade, but lead extraction was not performed.

摘要

心包积液有多种病因，包括感染、炎症和恶性肿瘤。心包积液的一个并发症是心脏压塞。在心脏压塞的情况下，及时进行超声心动图检查和稳定病情对于预防死亡至关重要。在此，我们报告一例在起搏器导线调整过程中发生右心室医源性微穿孔，导致延迟性心包积液并并发心脏压塞的病例。对于瓣膜性心内膜炎、囊袋感染、血栓形成或危及生命的心律失常病例，建议拔除导线；然而，在穿孔情况下尚无既定的指南。在本病例中，由于心脏压塞进行了紧急心包穿刺，但未进行导线拔除。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/20eedd7fe6fd/cureus-0012-00000009023-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/7043418434fe/cureus-0012-00000009023-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/2f8c4cf480e6/cureus-0012-00000009023-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/f37215ef79f5/cureus-0012-00000009023-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/20eedd7fe6fd/cureus-0012-00000009023-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/7043418434fe/cureus-0012-00000009023-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/2f8c4cf480e6/cureus-0012-00000009023-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/f37215ef79f5/cureus-0012-00000009023-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c03/7405971/20eedd7fe6fd/cureus-0012-00000009023-i04.jpg

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本文引用的文献

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2
2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction.2017年心律学会心血管植入式电子装置导线管理与拔除专家共识声明
Heart Rhythm. 2017 Dec;14(12):e503-e551. doi: 10.1016/j.hrthm.2017.09.001. Epub 2017 Sep 15.
3
Incidence of Cardiac Perforation With Conventional and With Leadless Pacemaker Systems: A Systematic Review and Meta-Analysis.
传统起搏器系统和无导线起搏器系统导致心脏穿孔的发生率：一项系统评价和荟萃分析。
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Pacing Clin Electrophysiol. 2014 Dec;37(12):1602-9. doi: 10.1111/pace.12472. Epub 2014 Jul 29.
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Late perforation by cardiac implantable electronic device leads: clinical presentation, diagnostic clues, and management.心脏植入式电子设备导线迟发性穿孔：临床表现、诊断线索和处理。
Clin Cardiol. 2010 Aug;33(8):466-75. doi: 10.1002/clc.20803.
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Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA).经静脉导线拔除：心律学会关于设施、培训、适应症及患者管理的专家共识：本文件获美国心脏协会（AHA）认可。
Heart Rhythm. 2009 Jul;6(7):1085-104. doi: 10.1016/j.hrthm.2009.05.020. Epub 2009 May 22.
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Management of subacute and delayed right ventricular perforation with a pacing or an implantable cardioverter-defibrillator lead.使用起搏或植入式心脏复律除颤器导线处理亚急性和延迟性右心室穿孔。
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Complications related to permanent pacemaker therapy.与永久性起搏器治疗相关的并发症。
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