Otaal Parminder S, Budakoty Sudhanshu, Kumar Rupesh, Singhal Manphool K
Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Family Med Prim Care. 2022 Feb;11(2):780-783. doi: 10.4103/jfmpc.jfmpc_448_21. Epub 2022 Feb 16.
Subacute right ventricular perforation by a pacemaker lead is a rare complication. Although occasionally asymptomatic, complicated cases are usually evidently symptomatic. Here, we report a 70-year-old man presented with mild left-sided chest pain three days after permanent pacemaker implantation. Suspected of ventricular perforation by the pacemaker lead on chest X-ray, device interrogation revealed non-corroborative parameters. This warranted a computed tomography (CT) scan, which confirmed the diagnosis, detected hemopneumothorax, and helped plan surgical intervention. The patient underwent surgical management with the placement of an epicardial pacemaker lead and was discharged after five days. Our case illustrates a rare report of subtle clinical presentation in a patient with subacute right ventricular perforation by a pacemaker lead complicated by hemopneumothorax. It further recapitulates the role of CT scan in providing definitive diagnostic information in managing such a patient. Anticipation of such a presentation is essential for primary care physicians, who are often a first contact point for a patient in the community. This requires a high index of suspicion in such patients presenting with minimal symptoms. Early recognition and timely referral by a family physician may prevent untoward consequences of device-related complications.
起搏器导线导致的亚急性右心室穿孔是一种罕见的并发症。尽管有时无症状，但复杂病例通常有明显症状。在此，我们报告一名70岁男性，在永久性起搏器植入术后三天出现轻度左侧胸痛。胸部X线怀疑起搏器导线导致心室穿孔，但设备询问显示参数不支持该诊断。这使得有必要进行计算机断层扫描（CT），CT扫描确诊了病情，检测到血气胸，并有助于制定手术干预计划。患者接受了手术治疗，植入了心外膜起搏器导线，五天后出院。我们的病例展示了起搏器导线导致亚急性右心室穿孔并伴有血气胸的患者罕见的细微临床表现。它进一步概括了CT扫描在为管理此类患者提供明确诊断信息方面的作用。对于基层医疗医生来说，预见到这种表现至关重要，他们通常是社区中患者的首个接触点。这就要求对症状轻微的此类患者保持高度怀疑。家庭医生的早期识别和及时转诊可能会预防与设备相关并发症的不良后果。
