A case report of successful permanent pacemaker implantation via the iliac vein

Strategy of pacemaker and electrode replacement for superior vena cava stenosis

Cardiac implantable devices are commonly used for superior vena cava stenosis, but there have been few reports of electrode replacement in the stenosed superior vena cava. A 73-year-old man was diagnosed with second-degree type II atrioventricular block and a permanent dual-chamber, rate-modulated pacing pacemaker was implanted 10 years previously. Because of depletion of the pacemaker battery and an increase in the ventricular pacing threshold, replacement of the pacemaker and ventricular electrode was required. During the operation, we found that the patient had severe superior vena cava stenosis on angiography, and this caused obstruction when a common guidewire was used to pass through the superior vena cava. After attempting various methods, we successfully passed through the vascular stenosis with a super slide guidewire and a long sheath, and completed replacement of the pacemaker and ventricular electrode. We summarize the related literature of superior vena cava stenosis related to a cardiac implantable device, and discuss the replacement strategy of this complication and other treatment options.

Dextrocardia with complete AV block and the implantation of a temporary pacemaker before cesarean section: A case report

RATIONALE

Patients with situs inversus totalis (SIT) and complete atrioventricular (AV) block are extremely rare, and only few cases have been reported up to now. Due to the rarity of such condition and its anatomical complexity, we reported this case as a reference for obstetricians, providing valuable insights into potential clinical treatment.

PATIENT CONCERNS

We reported a case of 30-year-old patient with complete AV block, and her heart rate was only about 45 beats per minute.

DIAGNOSES

The patient was diagnosed with term delivery with SIT and complete AV block.

INTERVENTIONS

A temporary pacemaker (TPM) was implanted before cesarean section (CS) because of complete AV block.

OUTCOMES

CS was performed successfully after the implantation of a TPM. The heart rate remained stable, and the 24-hour blood loss was limited.

LESSONS

This study presents a complex heart disease case which needed more frequent antenatal examination and restriction of physical activity. To reduce the risk of pregnancy, basic disease needed to be cured before pregnancy. Our findings could provide guidance for future clinical studies.

Dangerous twisted communications between external and internal iliac veins which might rupture during catheterization

In this report, four unusual communications between external and internal iliac veins of the left side have been presented. The lowest communication was the narrowest measuring about 2 mm in diameter, the second measured 6 mm, the third had a diameter of 7 mm and the last communication measured 5 mm in breadth. The upper three communications were twisted in a helical manner. The internal iliac vein had its normal tributaries except that the iliolumbar vein drained into the external iliac vein at the level of the third communication. The external iliac vein was slightly dilated just below the level of lowest communication.

Coronary artery bypass grafting with internal thoracic arteries may cause bilateral brachiocephalic vein occlusion, complicating pacemaker implantation

The number of patients with arrhythmia and ischaemic heart diseases is increasing. Patients with pacemaker implantation sometimes have brachiocephalic vein occlusion, and several aetiologies have been reported. However, coronary artery bypass grafting using the internal thoracic arteries is not fully discussed in the literature. We present a case of failed percutaneous pacemaker implantation due to bilateral brachiocephalic vein occlusion 8 years after coronary artery bypass grafting using the bilateral internal thoracic arteries. There were rich collateral veins consisting of hemiazygos and azygos veins. We then performed surgical implantation instead. Contrast CT or venography for such patients might be considered.