Leung, LWM; Gomes, J; Domenichini, G; Gallagher, MM
(2019)
Oesophageal perforation: an unexpected complication during extraction of a pacing lead. A case report.
Eur Heart J Case Rep, 3 (1).
ytz008.
ISSN 2514-2119
https://doi.org/10.1093/ehjcr/ytz008
SGUL Authors: Gallagher, Mark Michael
Abstract
Background: 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. Case summary: 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. Discussion: 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.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
Keywords: |
Case report, Complication, Oesophageal perforation, Pacing lead extraction, Transoesophageal echocardiography, Vascular trauma |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Eur Heart J Case Rep |
ISSN: |
2514-2119 |
Language: |
eng |
Dates: |
Date | Event |
---|
March 2019 | Published | 6 February 2019 | Published Online | 20 January 2019 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
PubMed ID: |
31020253 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/111046 |
Publisher's version: |
https://doi.org/10.1093/ehjcr/ytz008 |
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