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Implantable cardioverter defibrillator patch erosion in a heart transplant patient
S Chilukuri1, J P Herlihy, G A Massumkhani
1Pulmonary Medicine and Critical Care, St. Luke's Episcopal Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Leaving an automatic implantable cardioverter defibrillator (AICD) in place during heart transplantation can lead to serious complications. A migrated AICD patch eroded into the lung, causing hemoptysis, highlighting the need for complete device removal.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Device Complications
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Automatic implantable cardioverter defibrillators (AICDs) are used to manage life-threatening arrhythmias.
- Standard surgical practice for heart transplantation varies regarding AICD management.
Observation:
- A 57-year-old male recipient of an AICD and orthotopic heart transplant presented with hemoptysis.
- Imaging revealed migration of the AICD's left ventricular patch.
- The migrated patch had eroded into the patient's left lung.
Findings:
- The hemoptysis was directly attributed to the eroded AICD patch.
- The AICD patch was intentionally left in situ during the prior heart transplant surgery.
- This case illustrates a rare but severe complication of retained AICD components.
Implications:
- Complete removal of AICDs at the time of heart transplantation is recommended.
- Preventing retained device components can mitigate risks of erosion and hemorrhage.
- This finding may influence future surgical protocols for heart transplant recipients with prior AICD implantation.
Abstract:
A 57-year-old man who had received an automatic implantable cardioverter defibrillator and subsequent orthotopic heart transplant presented to medical attention for hemoptysis. The hemoptysis was caused by the migration of the left ventricular patch of the automatic implantable cardioverter defibrillator, which had been left in place at the time of orthotopic heart transplant. The patch had eroded into the left lung. We recommend that implantable cardioverter defibrillators be removed completely at the time of heart transplantation to prevent subsequent complications.