[Surgical Removal of a Transvenous Pacemaker Lead with the Right Atrial Perforation:Report of a Case]
Yoshimasa Hori1, Akio Shimoji, Toushi Maeda
1Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Insights
A rare cardiac perforation from a pacemaker lead was successfully managed with surgical lead removal and right atrial repair. This case highlights tailored management for pacemaker complications, especially with co-existing conditions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Device Complications
Background:
- Cardiac perforation by transvenous pacemaker leads is a rare but severe complication.
- Management depends on patient symptoms, pericardial effusion, hemodynamic status, and associated injuries.
Observation:
- A 70-year-old male presented with suspected right atrial perforation and pneumothorax due to a pacemaker lead.
- Computed tomography confirmed right atrial perforation and revealed a large laryngopharyngeal hemangioma compressing the trachea.
Findings:
- Despite hemodynamic stability, surgical lead removal was chosen due to the patient's significant laryngopharyngeal hemangioma.
- The procedure involved tracheotomy, lower hemisternotomy, lead extraction, and successful repair of the right atrial perforation.
Implications:
- This case demonstrates the importance of individualized surgical strategies for pacemaker lead cardiac perforation.
- Successful management in patients with complex comorbidities, like airway compression, is achievable.
Abstract:
Cardiac perforation by a transvenous pacemaker lead is an uncommon, but serious complication. Management strategies in pacemaker lead cardiac perforation depend on the symptoms, the presence of pericardial effusion, hemodynamic status, and injured neighboring organs. A 70-year-old man was admitted due to suspicious right atrial perforation with pneumothorax secondary to a transvenous pacemaker lead. Right atrial perforation was confirmed on computed tomography (CT). A large laryngopharyngeal hemangioma compressing the trachea was also observed. Although he was hemodynamically stable, we chose a surgical removal of a transvenous pacemaker lead considering his large laryngopharyngeal hemangioma. A tracheotomy followed by lower hemisternotomy were performed. A perforated pacemaker lead was observed on the right atrium. The lead was pulled out, and a hole in the right atrium was fixed. His postoperative course was uneventful.
