心外膜リードのペースメーカ感染に対して再開胸リード摘出術を施行した1例

Epicardial Pacemaker Infection Treated by Leads Removal via Re-sternotomy：Report of a Case

はじめに　ペースメーカ（PM）感染はまれながら重篤な合併症である．われわれは心外膜リードを用いたPM感染に対して，複数回の姑息的手術を行うも根治しえず，再開胸でのリード摘出術を要した1例を経験したので報告する．

A 69-year-old woman was diagnosed with a pacemaker infection after generator-exchange. Eight years ago, she underwent mitral and tricuspid valve replacement and had biventricular pacing with three pairs of epicardial leads placed in the right atrium, right ventricle, and left ventricle for left ventricular dysfunction. Skin perforation due to infection was detected 1 month after generator-exchange. At first, antibiotic treatment, generator-re-exchange, and pocket repositioning surgery were performed. Following all these failed attempts, a temporary pacemaker was placed, the infected generator was removed, and the lead was cut short. Eight days later, new intravenous caradiac resynchronization therapy pacemaker （CRT-P） implantation was performed. However, despite the repeat debridement, infection at the lead stumps recurred. Moreover, plain chest computed tomography （CT） revealed an abscess around the leads in the anterior mediastinum. Eventually, leads were removed under extracorporeal circulation via re-sternotomy. Postoperative course was uneventful, and she has been doing well without recurrence of infection for 6 years after operation.