右房穿孔した経静脈ペースメーカリードを外科的に抜去した1例

Surgical Removal of a Transvenous Pacemaker Lead with the Right Atrial Perforation：Report of a Case

はじめに　経静脈ペースメーカリードによる心臓穿孔はまれであるが，時には心タンポナーデや血気胸など深刻な合併症を起こしうる．そのような状況下では，外科的に抜去するのが安全である7）．

Cardiac perforation by a transvenous pacemaker lead is an uncommon, but serious complication. Management strategies in pacemaker lead cardiac perforation depend on the symptoms, the presence of pericardial effusion, hemodynamic status, and injured neighboring organs. A 70-year-old man was admitted due to suspicious right atrial perforation with pneumothorax secondary to a transvenous pacemaker lead. Right atrial perforation was confirmed on computed tomography （CT）. A large laryngopharyngeal hemangioma compressing the trachea was also observed. Although he was hemodynamically stable, we chose a surgical removal of a transvenous pacemaker lead considering his large laryngopharyngeal hemangioma. A tracheotomy followed by lower hemisternotomy were performed. A perforated pacemaker lead was observed on the right atrium. The lead was pulled out, and a hole in the right atrium was fixed. His postoperative course was uneventful.