リードレスペースメーカ留置中にガイドワイヤーが右室内に迷入し外科的抜去と三尖弁形成を要した1例

Guidewire Migration into the Right Ventricle During Leadless Pacemaker Insertion, Requiring Surgical Removal of the Guidewire and Tricuspid Valve Repair：Report of a Case

はじめに　中心静脈カテーテルの普及に伴いガイドワイヤーによる合併症の報告は増加傾向であるが1），リードレスペースメーカ留置の際にガイドワイヤーが抜去困難となった報告はまれである．本例はガイドワイヤーが右室内へ迷入したため，胸骨正中切開および人工心肺補助下での抜去を行ったが，抜去の際に三尖弁閉鎖不全症（TR）を合併したため心停止下での三尖弁形成術を行った．本例の治療方法や原因について考察を加えて報告する．

In a 77-year-old man, there was difficulty in removing a guidewire that had strayed into the right ventricle during leadless pacemaker insertion. Surgical removal was required. During removal of the wire, the tendon cords of the anterior tricuspid valve were pulled out, resulting in acute severe tricuspid regurgitation. The patient underwent tricuspid valve repair under cardiac arrest. He had a good postoperative course, a permanent pacemaker was implanted on postoperative day 14, and he was discharged on postoperative day 20. Although complications associated with catheter procedures have been increasing in recent years, there have been no reports of cases in which a guidewire became entangled in the tendon cords of the tricuspid valve. We discuss the cause of this case from the viewpoint of preventing recurrence and refer to acute tricuspid regurgitation that occurred during the removal of the catheter.