scholarly journals Pacemaker-Generated Stress Fracture of The Second Rib: A Case Report

2020 ◽  
Author(s):  
Jus Ksela ◽  
Mark Racman ◽  
Rok Zbacnik ◽  
Anze Djordjevic ◽  
Matevz Jan
Keyword(s):  
Physical Activity ◽  
Computed Tomography ◽  
Female Patient ◽  
Stress Fracture ◽  
Pulse Generator ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Direct Trauma ◽  
The Right ◽  
Intense Physical Activity

Abstract Background: Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.Case presentation: A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography - computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life.Conclusions: In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

scholarly journals Pacemaker-generated stress fracture of the second rib: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jus Ksela ◽  
Mark Racman ◽  
Rok Zbacnik ◽  
Anze Djordjevic ◽  
Matevz Jan
Keyword(s):  
Physical Activity ◽  
Computed Tomography ◽  
Female Patient ◽  
Stress Fracture ◽  
Pulse Generator ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Direct Trauma ◽  
The Right ◽  
Intense Physical Activity

Abstract Background Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections. Case presentation A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography—computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life. Conclusions In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

scholarly journals Pacemaker-generated stress fracture of the second rib: a case report

2020 ◽  
Author(s):  
Jus Ksela ◽  
Mark Racman ◽  
Rok Zbacnik ◽  
Anze Djordjevic ◽  
Matevz Jan
Keyword(s):  
Physical Activity ◽  
Computed Tomography ◽  
Female Patient ◽  
Stress Fracture ◽  
Pulse Generator ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Direct Trauma ◽  
The Right ◽  
Intense Physical Activity

Abstract Background: Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.Case presentation: A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography - computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life.Conclusions: In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

Minimally invasive permanent pacemaker implantation immediately after birth: from delivery room to heart surgery

2021 ◽  
pp. 1-3
Author(s):  
Mehmet Taşar ◽  
Nur Dikmen Yaman ◽  
Burcu Arıcı ◽  
Ömer Nuri Aksoy ◽  
Huseyin Dursin ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Atrioventricular Block ◽  
Heart Surgery ◽  
Pacemaker Implantation ◽  
Skin Incision ◽  
Permanent Pacemaker ◽  
Invasive Technique ◽  
Permanent Pacemaker Implantation ◽  
Congenital Atrioventricular Block ◽  
The Right

Abstract Introduction: Congenital atrioventricular block is diagnosed in uterine life, at birth, or early in life. Atrioventricular blocks can be life threatening immediately at birth so urgent pacemaker implantation techniques are requested. Reasons can be cardiac or non-cardiac, but regardless of the reason, operations are challenging. We aimed to present technical procedure and operative results of pacemaker implantation in neonates. Materials and methods: Between June 2014 and February 2021, 10 neonates who had congenital atrioventricular block underwent surgical operation to implant permanent epicardial pacemaker by using minimally invasive technique. Six of the patients were female and four of them were male. Mean age was 4.3 days (0–11), while three of them were operated on the day of birth. Mean weight was 2533 g (1200–3300). Results: Operations were achieved through subxiphoidal minimally skin incision. Epicardial 25 mm length dual leads were implanted on right ventricular surface and generators were fixed on the right (seven patients) or left (three patients) diaphragmatic surface by incising pleura. There were no complication, morbidity, and mortality related to surgery. Conclusion: Few studies have characterised the surgical outcomes following epicardial permanent pacemaker implantation in neonates. The surgical approach is attractive and compelling among professionals so we aimed to present the techniques and results in patients who required permanent pacemaker implantation in the first month of life.

scholarly journals Mucormycosis: An Uncommon Cutaneous Infection at Permanent Pacemaker-Implanted Site in a Very Low-Birthweight Baby

2022 ◽  
Author(s):  
Minati Choudhury ◽  
Jitin Narula ◽  
Milind P. Hote ◽  
Sarita Mohapatra
Keyword(s):  
Heart Block ◽  
Low Birthweight ◽  
Pulse Generator ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Cutaneous Infection ◽  
Very Low Birthweight ◽  
Congenital Complete Heart Block ◽  
Life Threatening

AbstractPermanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.

scholarly journals Management of Femoral Neck Stress Fracture in an Athlete Using Clodronic Acid: a Clinical Case Report

2019 ◽  
Vol 1 (11) ◽  
pp. 934-937
Author(s):  
Matteo Vitali ◽  
Pierluigi Pironti ◽  
Andreas Drossinos ◽  
Elisa Pesce ◽  
Vincenzo Salini
Keyword(s):  
Physical Activity ◽  
Stress Fracture ◽  
Functional Limitation ◽  
Imaging Study ◽  
X Rays ◽  
Clodronic Acid ◽  
Starting Point ◽  
History Of ◽  
Femoral Neck Stress Fracture ◽  
The Right

Abstract Stress fractures are common injuries caused by repetitive micro-traumas of the bone. Nowadays, they are widespread amongst the athletes and their treatment is mostly based on the limitation of physical activity, the application of ice, and the administration of analgesics and anti-inflammatory drugs. We present a case of a 26-year-old woman who reported a mono-cortical stress fracture in the anatomical neck portion of the right femur treated with Clody® 200 mg/4 ml. The patient is an amateur runner who complained a progressive pain and functional limitation of the hip joint. No history of recent trauma was present as well as X-rays evidence of fractures. A subsequent magnetic resonance imaging study showed the presence of a mono-cortical stress fracture in the anatomical neck portion of the right femur. The patient was treated with 1 vial of Clody® 200 mg/4 ml a day for 7 days, following 1 vial every 15 days for 2 months without any further therapy as well as physical activity limitation, showing a faster clinical and radiological recovery compared with the most of therapies described in the literature. Concerning our positive experience, the purpose of this study is to give a starting point for further research in order to enlarge the number of studies about that specific approach.

Positional syncope occurring just at the right time in a patient with a permanent pacemaker: a case report

2021 ◽  
Vol 71 (10) ◽  
pp. 2461-2463
Author(s):  
Syed Haseeb Raza Naqvi ◽  
Madiha Fatima ◽  
Pir Sheeraz Ali ◽  
Maqsood Alam ◽  
Muhammad Taha Khan ◽  
...  
Keyword(s):  
Case Report ◽  
Hospital Admission ◽  
Unusual Case ◽  
Pacemaker Implantation ◽  
Integrated Approach ◽  
Permanent Pacemaker ◽  
Pacemaker Lead ◽  
History Taking ◽  
Lead Fracture ◽  
The Right

We present an unusual case of positional syncope occurring years after pacemaker implantation due to pacemaker lead fracture resulting from subclavian-crush syndrome. The syncope occurred incidentally during hospital admission and was timely diagnosed using an integrated approach of history taking, examination findings, device interrogation and radiographic parameters. The patient subsequently underwent lead and device revision which led to resolution of her symptoms. Continuous...

scholarly journals Endovascular iliac vein recanalization for permanent pacemaker implantation in a patient who has long-term haemodialysis: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-4
Author(s):  
Nikolay Stoyanov ◽  
Valya Goranovska ◽  
Vassil Gegouskov ◽  
Vasil Velchev
Keyword(s):  
Superior Vena ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Iliac Vein ◽  
Permanent Pacemaker ◽  
Chronic Haemodialysis ◽  
Heart Atrium ◽  
Endovascular Recanalization ◽  
Pacemaker Placement ◽  
The Right

Abstract Background In chronic haemodialysis patients central veins occlusion occur very often. In such patients, permanent pacemaker placement implantation can be challenging and alternative approaches should be used. Case summary This is a case of 66-year-old male patient with complete atrioventricular block after a mitral valve (MV) surgery for endocarditis. The patient has a permanent surgically inserted haemodialysis catheter in right heart atrium after several unsuccessful attempts of endovascular recanalization of superior vena cava. A lead was implanted in the right ventricle after successful endovascular revascularization of the right iliac vein. The pacemaker was placed in a pouch on the right lower abdominal wall. Discussion To our knowledge, this is the first reported case where a permanent single-chamber pacemaker was implanted through the right iliac vein after successful endovascular recanalization in chronic haemodialysis patient post-MV replacement.

scholarly journals Permanent Pacemaker Implantation Challenged by an Elevated Left Hemidiaphragm

2021 ◽  
Vol 3 (1) ◽  
pp. 01-02
Author(s):  
Farla Louis
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
X Ray ◽  
Permanent Pacemaker Implantation ◽  
Left Hemidiaphragm ◽  
Chest X Ray ◽  
The Right

This is a case of a 93 year old patient who presented with a syncopal episode due to infra-nodal atrio-ventricular block (AVB) which required placement of a permanent pacemaker (PPM). The initial pre-procedure chest x-ray (CXR) showed an elevated left hemidiaphragm with shifting of the heart to the right making PPM implant challenging.

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