Riba Adam, Rashed Aref, Toth Roland, Tahin Tamas
Department of Cardiology, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary.
Department of Cardiac Surgery, Zala County Saint Rafael Hospital Ringgold Standard Institution, Zalaegerszeg, Hungary.
Thorac Cardiovasc Surg Rep. 2022 Nov 9;11(1):e61-e63. doi: 10.1055/s-0042-1757788. eCollection 2022 Jan.
Cardiac resynchronization therapy device with defibrillator (CRT-D) implantation is indicated for patients with a history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS, or high-degree atrioventricular block. A 67-year-old patient with dilated cardiomyopathy received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue. We decided to perform surgical reimplantation of the device using minithoracotomy: right atrial and right ventricular leads were introduced through the right atrial appendage and the left ventricular lead was inserted transapically. The device was implanted under the less scabby abdominal skin. We successfully applied the combination of transatrial and transapical lead placement, which has not been reported in the literature yet. It serves as an alternative method if the standard approach is not feasible.
植入式心脏再同步治疗除颤器（CRT-D）适用于有恶性室性心律失常病史、有症状心力衰竭、宽QRS波或高度房室传导阻滞的患者。一名67岁扩张型心肌病患者采用传统方法植入了CRT-D，但1个月后在装置上方诊断出皮肤坏死。从患者体内取出整个系统，我们采用负压伤口治疗来处理剩余组织。我们决定通过微创开胸手术重新植入该装置：右心房和右心室导线通过右心耳引入，左心室导线经心尖插入。该装置植入结痂较少的腹部皮肤下方。我们成功应用了经心房和经心尖导线置入相结合的方法，这在文献中尚未有报道。如果标准方法不可行，它可作为一种替代方法。
