scholarly journals Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium

Cureus ◽  
2020 ◽  
Author(s):  
Line Lisbeth Olesen
Author(s):  
Syed Haseeb Raza Naqvi ◽  
Ishfaq Ahmed ◽  
Pir Sheeraz Ali ◽  
Jehan Zab ◽  
Han Naung Tun

Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention. Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique. PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle.


1994 ◽  
Vol 17 (9) ◽  
pp. 505-507 ◽  
Author(s):  
H. Myint ◽  
J. McGregor ◽  
R. Edwards ◽  
N.P. Lucie

A case of spontaneous fracture of the outlet catheter of a totally implanted catheter system (Port-A-Cath) is presented. The outlet catheter was fractured at the entrance into the left subclavian vein twenty-one weeks after insertion and the distal part was embolized in the right ventricle. The embolized catheter fragment was retrieved by a ‘goose-neck’ snare via the right femoral vein. The awareness of a possible spontaneous fracture of the outlet catheter of a totally implanted catheter system (Port-A-Cath) is important to prevent accidental spillage of potent cytotoxic substances.


2000 ◽  
Vol 23 (8) ◽  
pp. 1318-1319
Author(s):  
ALAA A. SHALABY ◽  
PAUI A. DEMERS ◽  
PHILIP T. SAGER ◽  
MALCOLM M. BERSOHN

Author(s):  
Stefano Maffè ◽  
Paola Paffoni ◽  
Luca Bergamasco ◽  
Eleonora Prenna ◽  
Giulia Careri ◽  
...  

Giant coronary artery aneurysm is an uncommon disease, treated with surgical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential hemodynamic effects and may cause problems when we need to implant a cardiac device. We present a case of difficult pacemaker implantation in a patient with 3 syncopes, first-degree AV block and complete left bundle branch block on electrocardiogram. The patient presented a giant aneurysm of the right coronary artery (85 x 90 mm), thrombosed, with right atrial compression. The pacemaker implantation was hampered by the difficulty of passing the lead through the compressed right atrium; indeed, only with   simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure. This case demonstrates the utility of echocardiogram, in particular settings, in cardiac stimulation procedures.


2017 ◽  
Vol 4 (45) ◽  
pp. 23-25
Author(s):  
Aleksander Maciąg

The author describes the case of the superior vena cava occlusion detected during the new implantation of the pacemaker after lead extraction due to pocket infection. New electrode was implanted via the right subclavian vein. The occlusion in the superior vena cava was overcome with a guidewire (0.32 F) and a diagnostic catheter (JR2).


Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 685
Author(s):  
Naoya Kataoka ◽  
Teruhiko Imamura ◽  
Takahisa Koi ◽  
Hiroshi Ueno ◽  
Koichiro Kinugawa

Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09–1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05–2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.


1973 ◽  
Vol 38 (6) ◽  
pp. 786-788 ◽  
Author(s):  
Javier Verdura ◽  
Samuel Resnikoff ◽  
Juan Cardenas

✓ A safe, simple, surgical technique to cannulate the subclavian vein for ventriculoatrial shunts is described. The convenience of using this vessel to gain access to the right atrium when the internal jugular vein is not available is discussed, and experience with five cases is reported.


1995 ◽  
Vol 10 (5) ◽  
pp. 261-263 ◽  
Author(s):  
John M. Oropello ◽  
Andrew Leibowitz ◽  
Pedro Sepulveda ◽  
Henry Kuerer ◽  
Ernest Benjamin

A delayed bilateral pneumothorax complicated unilateral left subclavian vein catheterization and required treatment with tube thoracostomy. This case is unique in the demonstration that bilateral pneumothorax can present in a delayed fashion, and that, as a result of a previously formed pleuropleural fistula, it can occur in patients with a history of noncardiac surgery involving median sternotomy. Historical data on delayed pneumothoraces and bilateral pneumothoraces are presented.


2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Khalil Kanjwal ◽  
Michael Soos ◽  
Daniel Gonzalez-Morales ◽  
Ibrahim Shah ◽  
Mohan Madala ◽  
...  

We present a challenging case of a 75-year-old female with a history of paroxysmal atrial fibrillation (PAF) and symptomatic sick sinus syndrome (SSS) who presented for a dual chamber pacemaker implantation and was found to have persistent left superior vena cava and absent right superior vena cava with stenosis of the left subclavian vein. In this report, we discuss the implant technique in this group of patients.


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