Late Right Ventricular Perforation and Hemothorax After Transvenous Defibrillator Lead Implantation

A 53-year-old man with ischemic cardiomyopathy underwent prophylactic transvenous implantable cardioverter-defibrillator (ICD) placement. Nine days after the procedure, he had recurrent chest pain and left pleural effusion associated with a drop in hemoglobin. Hemothorax and right ventricular (RV) l...

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Bibliographic Details
Published in:The American journal of the medical sciences 2007-09, Vol.334 (3), p.209-211
Main Authors: Merla, Ramanna, Reddy, Nischita K., Kunapuli, Sanjay, Rosanio, Salvatore, Schwarz, Ernst, Vitarelli, Antonio
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiac perforation
Chest Pain - etiology
Computed tomography
Defibrillators, Implantable - adverse effects
Echocardiography, Transesophageal
Hemothorax
Humans
Implantable cardioverter-defibrillator
Male
Medical sciences
Middle Aged
Pneumology
Radiography, Thoracic
Respiratory system : syndromes and miscellaneous diseases
Treatment Outcome
Ventricular Dysfunction, Left - etiology
Wounds and Injuries - etiology
Wounds and Injuries - pathology
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Summary:A 53-year-old man with ischemic cardiomyopathy underwent prophylactic transvenous implantable cardioverter-defibrillator (ICD) placement. Nine days after the procedure, he had recurrent chest pain and left pleural effusion associated with a drop in hemoglobin. Hemothorax and right ventricular (RV) lead perforation were suspected on chest radiography and lead interrogation, and confirmed by thoracentesis and contrast computed tomography (CT) scanning, respectively. The CT-scan clearly demonstrated the RV lead tip projecting beyond the cardiac border into the anterior left pleural space. The perforated lead was removed in the operating room under transesophageal echocardiography guidance and a new transvenous lead was successfully placed a month later. This case highlights: 1) the importance of suspecting late RV perforation in patients with ICD implantation presenting with recurrent chest pain and/or pleural effusion; 2) the value of CT in its diagnosis; and 3) the need for a more careful management of this potentially life threatening complication.
ISSN:0002-9629
1538-2990
DOI:10.1097/MAJ.0b013e31814254c5