小児において心不全を呈した心外膜リードによる心絞扼の1例

Cardiac Strangulation Induced by Epicardial Pacemaker Leads Causing Heart Failure；Report of a Case

はじめに　小児の心外膜リードによる心絞扼は，まれではあるが，致命的になりうる重大な合併症である．本邦において2013年4月に主要3学会から注意喚起がうながされた1）が，検索しうる限り2018年までに22例の報告があり，うち5例が死亡している2，3）．われわれは心外膜リードの心絞扼により心不全症状を呈した1例を経験したので報告する．

A 5-year-old girl has a history of epicardial VVI-pacemaker implantation due to congenital heart block at the age of 2 months. Five years later, she developed heart failure at the same time of battery depletion. The chest X-ray indicated the loop formation of the epicardial leads and the echocardiogram demonstrated paradoxical movement of ventricles. The 3-dimensional computed tomography finally revealed strangulation of biventricular apex caused by loop of the leads. She underwent reoperation. Cardiac strangulation was relieved by total removal of the loop and repositioning of right atrial and ventricular electrodes in a gentle curve of the leads. She was discharged and doing well. Cardiac strangulation is a rare, but it can be lethal. Therefore epicardial pacemaker leads should not be positioned around the ventricle with excessive redundancy.