Gondi B, Nanda N C
Circulation. 1981 Jul;64(1):97-106. doi: 10.1161/01.cir.64.1.97.
Five patients (four adults and one child) with clinically suspected myocardial perforation by temporary transvenous pacemakers were studied by real-time, two-dimensional echocardiography. In three patients, the catheters were visualized passing through the right ventricular apical wall with the tip located outside the cardiac border. In one patient the catheter perforated the atrioventricular septum and entered the left ventricle with the tip lodged against the posterior wall. In another patient, the catheter had partially penetrated the ventricular septum near the apex. Pericardial effusion was observed in two patients, in one of whom it was localized to the site of perforation. No patient had evidence of cardiac tamponade. In four patients, the catheters were withdrawn under echocardiographic visualization and the catheter tips could be seen moving from the abnormal locations back into the right-heart chambers. Perforation was verified at autopsy in two patients, including one in whom the catheter was not withdrawn. Real-time, two-dimensional echocardiography appears to be valuable in the diagnosis of pacemaker perforation.
对5例临床怀疑因临时经静脉起搏器导致心肌穿孔的患者（4名成人和1名儿童）进行了实时二维超声心动图研究。3例患者中，可见导管穿过右心室心尖壁，尖端位于心脏边界外。1例患者中，导管穿破房室间隔进入左心室，尖端抵住后壁。另一例患者中，导管在靠近心尖处部分穿透室间隔。2例患者观察到心包积液，其中1例局限于穿孔部位。无患者有心脏压塞的证据。4例患者在超声心动图引导下拔出导管，可见导管尖端从异常位置移回右心腔。2例患者经尸检证实穿孔，其中1例导管未拔出。实时二维超声心动图在起搏器穿孔的诊断中似乎很有价值。
