Department of Cardiovascular Surgery, Cheng Du Shang Jin Nan Fu Hospital, West China Hospital, Sichuan University, Sinchuan Province, 610041, Shandong, China.
J Cardiothorac Surg. 2024 Jul 20;19(1):462. doi: 10.1186/s13019-024-02836-2.
High-grade atrioventricular block is the primary reason for epicardial permanent pacemaker implantation during the perioperative period in patients with congenital heart disease. Due to the smaller diameter of venous vessels in children, epicardial permanent pacemaker implantation is usually a preferred choice, we report one pediatric patient who received epicardial permanent pacemaker implantation using a new approach.
We present the case of a 2-year-old girl who underwent the modified Konno procedure and Pulmonary valvuloplasty surgery and presented after surgery with a High-grade atrioventricular block. At over 20 days after the patient underwent a redo-sternotomy which epicardial permanent pacemaker implantation. Medtronic Model 4965 Capsure Epi ® steroid-eluting unipolar epicardial pacing lead was immobilized on the surface of the right ear. The Medtronic 3830 pacing lead was screwed obliquely and clockwise under direct view from the surface of the right ventricle to the endocardium near the interventricular septum. The patient's recovery was uneventful.
In this case report, we demonstrate the feasibility and potential benefits of using the Medtronic 3830 lead for epicardial pacing in a pediatric patient with severe cardiac complications following surgery for congenital heart disease. This approach offers a viable alternative to traditional epicardial pacing methods, particularly in complex cases where conventional leads fail to provide stable pacing thresholds.
在先天性心脏病患者围手术期,高级房室传导阻滞是心外膜永久起搏器植入的主要原因。由于儿童静脉血管直径较小,心外膜永久起搏器植入通常是首选,我们报告了一例使用新方法进行心外膜永久起搏器植入的儿科患者。
我们报告了一例 2 岁女孩,她接受了改良 Konno 手术和肺动脉瓣成形术,术后出现高级房室传导阻滞。在患者接受胸骨切开术翻修 20 多天后,进行了心外膜永久起搏器植入。Medtronic Model 4965 Capsure Epi ® 皮质类固醇洗脱单极心外膜起搏导线固定在右耳表面。在右心室表面直视下,将 Medtronic 3830 起搏导线斜向顺时针拧入,直至靠近室间隔的心内膜。患者恢复顺利。
在本病例报告中,我们展示了在先天性心脏病手术后出现严重心脏并发症的儿科患者中,使用 Medtronic 3830 导线进行心外膜起搏的可行性和潜在益处。这种方法为传统心外膜起搏方法提供了可行的替代方案,特别是在常规导线无法提供稳定起搏阈值的复杂情况下。