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右心室导线穿孔致心包积气的机制与处理

The Mechanism and Management of Pneumopericardium Caused by Right Ventricular Lead Perforation.

作者信息

Komaki Tomo, Ueno Yuuki, Mohri Noriyuki, Ideishi Akihito, Tashiro Kohei, Miura Shin-Ichiro, Ogawa Masahiro

机构信息

Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan.

Department of Clinical Laboratory Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

出版信息

Cardiol Res. 2024 Dec;15(6):472-476. doi: 10.14740/cr1738. Epub 2024 Dec 3.

DOI:10.14740/cr1738
PMID:39698006
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11650576/
Abstract

An 83-year-old man underwent dual-chamber pacemaker placement for complete atrioventricular block at another hospital. The active-fixation ventricular lead was positioned on the free wall of the anterior right ventricle. Ventricular pacing failure occurred on the day after pacemaker implantation, and fluoroscopy revealed right ventricular (RV) lead perforation. The patient was transferred to our hospital, and chest computed tomography revealed a severe pneumothorax and moderate pneumopericardium. These symptoms were relieved after chest tube drainage, and the patient's hemodynamics stabilized. The RV lead was percutaneously removed using simple traction under fluoroscopic guidance with cardiac surgical backup and was uneventfully refixed to the RV septum. Although there have been several reports of pneumopericardium caused by atrial lead perforation, there are very few cases related to RV lead. Pneumopericardium complicated by pneumothorax due to RV lead perforation can be relieved using chest tube drainage without the need for pericardiocentesis.

摘要

一名83岁男性在另一家医院因完全性房室传导阻滞接受了双腔起搏器植入术。主动固定型心室导线置于右心室前壁游离壁。起搏器植入术后次日发生心室起搏失败，透视显示右心室（RV）导线穿孔。患者被转至我院，胸部计算机断层扫描显示严重气胸和中度心包积气。胸腔闭式引流后这些症状缓解，患者血流动力学稳定。在心脏外科备用的情况下，在透视引导下通过简单牵引经皮取出RV导线，并顺利重新固定至RV间隔。虽然有几篇关于心房导线穿孔导致心包积气的报道，但与RV导线相关的病例非常少。RV导线穿孔并发气胸的心包积气可通过胸腔闭式引流缓解，无需心包穿刺。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/d9a884d4e743/cr-15-472-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/9a7dc9d60fc9/cr-15-472-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/b95cbf8aa7cb/cr-15-472-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/8dc3b5bc3653/cr-15-472-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/3df2dcc299ef/cr-15-472-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/d9a884d4e743/cr-15-472-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/9a7dc9d60fc9/cr-15-472-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/b95cbf8aa7cb/cr-15-472-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/8dc3b5bc3653/cr-15-472-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/3df2dcc299ef/cr-15-472-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/15ba/11650576/d9a884d4e743/cr-15-472-g005.jpg

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本文引用的文献

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双腔起搏器植入术后并发对侧气胸、纵隔气肿及心包积气1例
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Postural Conversion Computed Tomography for the Diagnosis of Pneumopericardium due to Perforation by the Active Atrial Lead.用于诊断主动心房导线穿孔所致心包积气的体位转换计算机断层扫描
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Contralateral pneumothorax and pneumopericardium after dual-chamber pacemaker implantation: Mechanism, diagnosis, and treatment.双腔起搏器植入术后对侧气胸和心包积气：机制、诊断与治疗
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