ヒグチ　サトシ   HIGUCHI Satoshi   樋口　諭    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門講師
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Transvenous lead extraction in a patient with polysplenia and inferior vena cava defect.
掲載誌名	正式名：Journal of cardiology cases 略　 称：J Cardiol Cases ISSNコード：18785409/18785409
掲載区分	国外
巻・号・頁	23(1),pp.41-44
著者・共著者	Kataoka Shohei, Shoda Morio, Saito Satoshi,, Yagishita Daigo, Yazaki Kyoichiro,, Higuchi Satoshi,, Kanai Miwa, Ejima Koichiro, Hagiwara Nobuhisa
発行年月	2021/01
概要	A 28-year-old woman with polysplenia was referred to our hospital for atrial lead failure. She had undergone an intracardiac repair (ICR) for incomplete atrioventricular septal defect and the implantation of epicardial pacing leads due to complete atrioventricular block at the age of 1 year. When she was 13 years old, an endocardial dual-chamber pacemaker was implanted via the right subclavian vein because of epicardial lead failure. The contrast-enhanced computed tomography scan revealed an inferior vena cava defect with an azygos vein connection to the superior vena cava, occlusion of the right brachiocephalic vein, a defect of the left brachiocephalic vein, and a persistent left superior vena cava ligated at the ICR. Therefore, lead exchange was indicated. During the operation, the temporary pacing lead and the guidewire for emergent deployment of the Bridge Occlusion Balloon® were advanced through the azygos vein and placed at the right ventricle and the hepatic vein, respectively. Both 11-Fr and 13-Fr mechanical rotational dilator sheaths were needed for the lead extraction owing to dense calcification and tight adhesions. The atrial lead was successfully extracted without any complications despite extremely restricted venous access. A new atrial lead was inserted through the space created by the 13-Fr sheath. <Learning objective: Transvenous lead extraction in patients with polysplenia is technically challenging. These patients often undergo pacemaker implantation in childhood, which results in tight adhesions and dense calcifications on the leads, and venous access is extremely restricted. It may be impossible to use a snare and deploy the endovascular balloon to prevent a catastrophic complication from the right femoral vein to the superior vena cava in cases of the inferior vena cava defect.>.
DOI	10.1016/j.jccase.2020.09.004
PMID	33437340