The Mechanism and Management of Pneumopericardium Caused by Right Ventricular Lead Perforation
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Updated: Jun 4, 2025

Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Tomo Komaki1, Yuuki Ueno1, Noriyuki Mohri1
1Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan.
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.
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