Kang Ryeonshi, Tanaka Toshikazu D, Yoshitake Michio, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan.
Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Eur Heart J Case Rep. 2022 Feb 23;6(3):ytac092. doi: 10.1093/ehjcr/ytac092. eCollection 2022 Mar.
Cardiac strangulation (CS) is a rare but potentially devastating complication caused by the leads of an epicardial pacemaker (EP). Most cases have been reported in paediatric patients, and there has been no report wherein the diagnosis was made in a living, adult patient, and treated successfully.
A 31-year-old woman with a history of atrial septal defect (ASD) patch closure and EP implantation for congenital atrial stand-still presented with dyspnoea on exertion. The blood investigation of the patient showed liver dysfunction, chest radiography showed pulmonary artery dilatation, and transthoracic echocardiography showed right chambers dysfunction. Right heart catheterization showed haemodynamics similar to those of constrictive pericarditis, eventually leading to the diagnosis of CS due to EP leads. The patient was successfully operated upon.
We reported the first case where CS was diagnosed in adulthood and successfully treated with surgical intervention. Cardiac strangulation is challenging to diagnose because of the small number of cases reported and the lack of definitive diagnostic algorithms or criteria. Surgical EP lead removal should be performed without hesitation in cases where CS is considered the primary aetiology of critical symptoms or complications because surgical removal is the only fundamental treatment for CS. In addition, paediatric patients undergoing EP implantation need for close follow-up.
心脏绞窄（CS）是一种由心外膜起搏器（EP）导线引起的罕见但可能具有毁灭性的并发症。大多数病例报告于儿科患者，尚无在成年存活患者中作出诊断并成功治疗的报道。
一名31岁女性，有房间隔缺损（ASD）修补术及因先天性心房静止植入EP的病史，出现劳力性呼吸困难。患者血液检查显示肝功能异常，胸部X线显示肺动脉扩张，经胸超声心动图显示右心腔功能障碍。右心导管检查显示血流动力学与缩窄性心包炎相似，最终诊断为EP导线导致的CS。患者手术成功。
我们报告了首例在成年期诊断出CS并通过手术干预成功治疗的病例。由于报道的病例数量少且缺乏明确的诊断算法或标准，心脏绞窄的诊断具有挑战性。在CS被认为是严重症状或并发症的主要病因的情况下，应毫不犹豫地进行手术取出EP导线，因为手术取出是CS的唯一根本治疗方法。此外，接受EP植入的儿科患者需要密切随访。
