Kumar Rupesh, Halder Vikram, Shrimanth Yamasandi Siddegowda, Gawalkar Atit A, Chauhan Rajeev, Prasad Krishna, Rohit Manoj Kumar Ukadbhai, Karri Sujithareddy, Walia Sheenam, Singh Avneet
Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Cardiol Cases. 2021 Dec 8;25(4):207-209. doi: 10.1016/j.jccase.2021.09.014. eCollection 2022 Apr.
Pacemaker implantation in the paediatric population is associated with significant perioperative complications. We report a child with atrial septal defect who developed cyanosis following pacemaker implantation. An 8-year-old male child presented to us with fever of 2 months, along with cyanosis and clubbing. He underwent endocardial transvenous pacemaker implantation for congenital complete heart block. His echocardiography revealed right atrial vegetation (1 × 1 cm), moderate tricuspid regurgitation, and a prolapsed lead loop extending into the right ventricular outflow tract and pulmonary valve causing severe obstruction of pulmonary valve. He was started on empirical treatment followed by sensitive antibiotics based on culture report; however due to recurrent ventricular tachycardia he was taken for emergency surgery. He underwent closure of atrial septal defect, removal of pulse generator, removal of endocardial leads/vegetation, and pulmonary valve repair. Postoperative echocardiography revealed mild tricuspid regurgitation and resolution of pulmonic stenosis. This case presents a rare complication of severe right ventricular outflow tract obstruction following pacemaker implantation. < Lead displacement into pulmonary artery is a rare complication most often seen with abandoned pacemaker lead. Infective endocarditis involving pacemaker lead should be treated by prompt removal of lead and antibiotics.>.
小儿人群植入起搏器与显著的围手术期并发症相关。我们报告一例患有房间隔缺损的儿童，其在起搏器植入后出现发绀。一名8岁男童因持续2个月的发热、发绀和杵状指前来就诊。他因先天性完全性心脏传导阻滞接受了心内膜经静脉起搏器植入术。他的超声心动图显示右心房赘生物（1×1厘米）、中度三尖瓣反流以及一个脱垂的导线环延伸至右心室流出道和肺动脉瓣，导致肺动脉瓣严重梗阻。他开始接受经验性治疗，随后根据培养报告使用敏感抗生素；然而，由于反复出现室性心动过速，他接受了急诊手术。他接受了房间隔缺损修补术、脉冲发生器移除术、心内膜导线/赘生物移除术以及肺动脉瓣修复术。术后超声心动图显示轻度三尖瓣反流，肺动脉狭窄得到缓解。本病例呈现了起搏器植入后严重右心室流出道梗阻这一罕见并发症。<导线移位至肺动脉是一种罕见并发症，最常见于废弃的起搏器导线。累及起搏器导线的感染性心内膜炎应通过及时移除导线和使用抗生素进行治疗。>
