心囊内の出血なく左血胸でペースメーカリードの右室穿孔が判明した1例

Left Hemothorax without Pericardial Effusion due to Pacing Lead Penetration Through Right Ventricular Wall：Report of a Case

はじめに　ペースメーカリードの穿孔は生命にかかわる合併症であり，血行動態が不安定な場合，外科的治療を要する．われわれは，ペースメーカリードの右室穿孔で心タンポナーデにいたることなく左血胸のみを生じ，外科的加療を必要とした症例を経験したため報告する．

Cardiac perforation by a pacemaker lead that causes left hemothorax without pericardial effusion is rare and life threatening. So, we report a surgically salvaged case. A 55-year-old man underwent insertion of adevice for cardiac resynchronization therapy and defibrillation. On the second postoperative day, the patient fell into shock state after defecation. Electrocardiogram showed pacing failure and computed tomography （CT） showed left hemothorax without pericardial effusion. A drainage tube was placed in the left pleural cavity, and bleeding was massive and continuous. We then performed emergency surgery for suspected cardiac perforation by the pacemaker lead. The right ventricular lead had penetrated the ventricle, which was surgically repaired.