A lead extraction procedure commenced to remove a right atrial (ra) and a right ventricular (rv) lead due to non function and the rv lead delivering inappropriate shocks.Spectranetics lead locking devices (llds) were inserted into each lead to provide traction.The physician began the extraction attempt of the rv lead using a spectranetics 14f glidelight laser sheath, with progress stalling at the superior vena cava (svc)/innominate junction with obvious lead interaction with the ra lead.The physician then switched to the ra lead, progress stalling in the same area.The physician upsized to a 16f glidelight device and the extraction of the ra lead was successful shortly afterward.After approximately 2 minutes post extraction, the patient's blood pressure dropped.Rescue efforts began immediately, including rescue balloon, administration of blood products, and sternotomy.The surgical team worked for 13 minutes to stabilize the patient.No obvious tear was noted in either the svc or in the heart, but large clotting was noted, and the tear was presumed closed.After consultation with colleagues, it was decided to attempt removal of the rv lead, since the patient's chest was open and the team had full access.The 16f glidelight device was used over the rv lead with minimal lasing before another immediate blood pressure drop occurred.The patient was placed on bypass and further blood products were administered.A high svc perforation was noted by surgeons (mdr #1721279-2022-00001).The repair to the svc perforation was successful and the physicians decided to leave the rv lead within the patient.The physician attempted to unlock the lld from the rv lead, but the lead/lld had already been stretched with traction and could not be unlocked successfully.The rv lead and lld within it were cut and capped and remained in the patient.The patient survived the procedure.This report captures the lld which would not unlock and was cut and capped within the rv lead and remained in the patient.
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