Oesophageal perforation: an unexpected complication during extraction of a pacing lead. A case report.

Details

Serval ID
serval:BIB_753541411CBE
Type
Article: article from journal or magazin.
Collection
Publications
Title
Oesophageal perforation: an unexpected complication during extraction of a pacing lead. A case report.
Journal
European heart journal. Case reports
Author(s)
Leung LWM, Gomes J., Domenichini G., Gallagher M.M.
ISSN
2514-2119 (Electronic)
ISSN-L
2514-2119
Publication state
Published
Issued date
03/2019
Peer-reviewed
Oui
Volume
3
Number
1
Pages
ytz008
Language
english
Notes
Publication types: Case Reports
Publication Status: epublish
Abstract
Peri-procedural transoesophageal echocardiography (TOE) is important in monitoring and minimizing major complications during pacing lead extraction. It is a widely accepted precautionary measure, especially in extractions considered to be higher risk. Pacing lead extraction may be challenging, and it is associated with significant risk of major bleeding from vascular trauma.
We present a case of an 87-year-old woman who had an extraction of a ventricular pacing lead that had perforated to an extra-cardiac location, most likely to the left pleural space. Peri-procedural TOE was used as a precaution. The entire pacing lead was successfully extracted with gentle traction using standard equipment (mechanical technique). Extraction was followed by development of pneumomediastinum and a left pleural effusion, initially attributed to pulmonary injury from the pacing lead but which proved to be related to oesophageal injury from the TOE.
Transoesophageal echocardiography-related complications are uncommon but should be considered in cases of unexpected post-procedural deterioration. Clinical deterioration after a seemingly uneventful procedure should prompt a thorough case review. A systematic approach should be applied to identify the offending cause and enable corrective measures to be undertaken. This case report is an important reminder to all operators utilizing TOE for peri-procedural purposes that this precautionary measure itself also independently exposes the patient to additional risk.
Keywords
Case report, Complication, Oesophageal perforation, Pacing lead extraction, Transoesophageal echocardiography, Vascular trauma
Pubmed
Web of science
Open Access
Yes
Create date
03/03/2024 18:51
Last modification date
11/03/2024 8:17
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