• Journal of Chest Surgery
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• 제48권2호
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• pp.129-133
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• 2015

Severe and permanent tricuspid regurgitation induced by pacemaker leads is rarely reported in the literature. The mechanism of pacemaker-induced tricuspid regurgitation has been identified, but its management has not been well established. Furthermore, debate still exists regarding the proper surgical approach. We present the case of a patient with severe tricuspid regurgitation induced by a pacemaker lead, accompanied by triple valve disease. The patient underwent double valve replacement and tricuspid valve repair without removal of the pre-existing pacemaker lead. The operation was successful and the surgical procedure is discussed in detail.

• Journal of Chest Surgery
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• 제14권2호
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• pp.168-174
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• 1981

Since cardiac pacemaker was first totally implanted by Chardack, Gage and Greatbatch [1966], the electrical circuity of the cardiac pacemaker has been improved, modified, and refined. The problem of transvenous electrodes, however, is still remained; this may be due to electrode displacement, exit and/or entrance block, lead fracture and insulation defects. In permanent cardiac pacing, Irreversible loss of function of the transvenous electrode catheter eventually requires insertion of new lead. Authors now report one case that disclosed easy displacement of electrode tip in early phase of implantation and then two years and five months later, malfunctioning electrode could not be withdrawn from the cardiovascular system because it has become firmly enclosed by fibrous tissue along its course from the vein tract to the right ventricle. Under such circumstances, the electrode catheter tip was left in tricuspid annulus after being sutured at its entrance and burying the loop of lead in generator pocket. New other one electrode was then reimplantation through left external jugular vein.

• Journal of Chest Surgery
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• 제9권2호
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• pp.265-270
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• 1976

Implantation of a permanent pacemaker is a widely accepted procedure for the patient with complete heart block.As a result of these device, the prognosis for patients with Adams-Stokes syndrome caused by complete A-V block and other cardiac arrhythmia have become much more optimistic. Permanent pacemaker implantation by means of a transvenous approach has made the operative risk much less and the procedure simpler. However, a number of complications have been reported in the literature regarding transvenous endocardial pacemaker implantation during the last a decade. The patient presented in this paper is a 26-year old girl who was implanted with a permanent pacemaker at 14 years of age because of a congenital A-V block. Following first exchange of pulse generator, the electrode (lead) was fractured, so that by the pulse generator, a change to the transvenous technique of implantation was made, After this, there were episodes of recurrent wound infection on three occasions, even though the site of pulse generator implantation was exchanged to the contralateral side of chest wall, massive doses of antibiotics were administered and sensitivity tests for coagulase positive staphylococcal infection were performed. Though there was no definite evidence of blood stream infection by blood culture, we decided not to use the transvenous technique and not to implant the pulse generator in the chest wall because the venous system and the entire anterior chest wall appeared to be diseased or contaminated by virulent pyogenic organisms. Finally this intractable systemic and local wound infection was successfully controlled by myocardial lead implantation via a subxiphoid approach and implantation of the pulse generator far down in the abdominal wall. The causes and routes of recurrent wound infection and possible blood born infection in this particular patient are still obscure. We strongly believe that myocardial pacemaker implantation is much safer than transvenous endocardial pacemaker implantation & myocardial pacemaker implantation is a definite method for controlling such an intractable wound infection. following transvenous pacemaker implantation.

• Journal of Chest Surgery
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• 제17권3호
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• pp.356-361
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• 1984

During the period from January 1982 to June 1984 we implanted permanent pacemakers in 18 patients who received open heart surgery at Yonsei University Hospital. 1.In 11 patients, open heart surgery was performed at Yonsei University Hospital and new surgical induced heart blocks were developed and implantations of permanent pacemaker were done. 2.Total 1035 open heart surgeries were done and implantations of pacemaker were performed in 11 cases. [1.06%]. After total correction of TOF [215 cases] implantations of pacemaker were done in 3 cases. [1.4%] Implantations of pacemaker were 0.37% after VSD repair, 0.78% after ASD repair, 5.9% after ECD repair, 0.48% after MVR and 2.0% after AVR. 3.Causes were complete A-V block, sick sinus syndrome and A-V dissociation. 4.Heart blocks were developed immediately after bypass stop in 8 patients. 5.Implantations of pacemaker were done at more than 2 weeks after open heart surgery. 6.Local anesthesia was done in adult and general anesthesia in infants. Locations of pulse generator were subxiphoid, subcostal & subclavian. Position of pulse generator was between subcutaneous fat layer and muscle layer. 7.Types of pulse generator were VVI, VDD and AAI. 8.The postoperative complications included infection, pacing failure, sensing failure and lead dislodgment.

• Journal of Yeungnam Medical Science
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• 제11권1호
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• pp.181-185
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• 1994

저자들은 완전방실블록 환자에서 쌍극의 영구심장박동기를 이식후에도 계속되는 실신발작을 보여 단극의 영구심장박동기로 바꾼 후 그 증상이 소실된 예를 경험하였기에 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제38권4호
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• pp.312-315
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• 2005

심내막 심박조율기 이식 후 도자에 의한 심장 천공으로 출혈이 발생하는 경우는 드물다. 본원에서는 영구 경정맥 심박조율기 이식 후 우심실 천공에 의한 좌측 혈흉이 발생하였던 환자를 경험하였기에 보고하는 바이다. 수술 소견 상 심박조율기 도자가 우심실 천공 후 심낭막과 흉막을 차례로 관통하였으나 혈심낭 소견은 관찰되지 않았다.

• 한국임상수의학회지
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• 제24권3호
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• pp.414-418
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• 2007

2.8살 된 암컷 비글종 개 (체중 11kg)가 운동 불내성과 간헐적인 실신증상을 보여 내원하였다. 청진상 불규칙하게 불규칙한 심장박동과 지속적인 맥박결손이 청진되었다. 심전도상에 3도 방실차단 소견이 관찰되었다. 환자는 임상증상 개선을 위하여 경정맥을 통한 영구적인 박동조절기(pacemaker)를 장착하였다. 그 결과 환자는 더 이상 실신증상을 보이지 않았고 주인과 함께 산책을 나갈 수 있을 만큼 임상증상이 개선되었다. 현재까지 박동조절기 장착과 관련된 합병증 없이 잘 생존하고 있다.

• Journal of Chest Surgery
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• 제43권1호
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• pp.86-88
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• 2010

심박동기는 동기능 부전 증후군에서부터 완전 방실차단까지 서맥의 치료에 가장 보편적으로 사용되는 중재적 치료다. 일반적으로 경정맥을 통한 심내 심박동기를 많이 사용하고 있으나 감염 및 혈전증, 박동기의 기능부전, 부정맥, 심근천공, 삼첨판 폐쇄부전증 등의 합병증이 발생할 수 있다. 심박동기의 감염은 전신감염으로 이행되어 환자 상태가 빠르게 악화될 수 있으므로 감염으로 의심되면 제거하는 것이 원칙이다. 추나 올가미 등을 이용한 방법등 비수술적인 방법외에도 체외순환을 이용한 적극적인 제거도 환자 상태에 따라 고려해야 할 것이다. 감염된 심박동기를 체외순환을 이용하여 제거한 두 개의 증례를 보고하는 바이다.

• Archives of Plastic Surgery
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• 제32권6호
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• pp.753-756
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• 2005

In the cases of severe arrythmia and conduction failure, a permanent implanted pacemaker is considered an essential treatment modality with less complication rate, broad indications and low morbidity. However, some pacemakers needs to be removed or replaced due to infection, in need of a lead upgrade, elective replacement, conduction failure or insulation failure. The most common indication for pacemaker extraction is infection. Conservative treatments such as administration of intravenous antibiotics and limitation of debridement are not effective and the removal of the entire pacing system is considered to be the best approach to pacemaker pocket infection. Although a locking stylet, a laser sheath and other newer methods of transvenous lead extraction have been proven to be effective, all leads cannot be removed. Moreover, major complications such as, cardiac tamponade and respiratory arrest during leads extraction procedure should not be ignored. We experienced two cases of exposed pacemakers in the subclavicular region. After removing the pacemaker body, exposed proximal lead was pulled out and cut off. The end of remnant external insulation tube was tied to prevent infection propagation between external insulation tube and inner metalic coil. Wounds were covered by local flap coverage. No other problems were detected during the one-year follow-up. Since there are few reports on lead-preserving method of treating limited infection of exposed pacemakers, we would like to present our new method for treating exposed pacemakers.

• Journal of Yeungnam Medical Science
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• 제31권2호
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• pp.113-116
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• 2014

A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.