A lead extraction procedure commenced to remove a right ventricular (rv) lead due to recall.A spectranetics lead locking device (lld) was inserted into the rv lead to provide traction to the lead.The physician also used a spectranetics 16f glidelight laser sheath during the procedure.While the physician was lasing within the superior vena cava (svc)/innominate junction, the rv lead freed.The glidelight device and the lead were removed and the patient became hypotensive.An effusion was noted, and the cardiothoracic surgeon immediately entered the room.A sternotomy was performed and a small perforation in the innominate vein (see mdr #1721279-2021-00203) and a large perforation in the distal svc and ra junction were discovered.The physician noted that the glidelight device never made it down to the svc and ra junction, but that the lead must have been attached and when it pulled off the wall as traction was being applied, the perforation occurred.The repairs were successful and the patient survived the procedure.This report captures the lld providing traction to the rv lead when the svc and ra junction perforation occurred.There was no alleged malfunction of any spectranetics devices in use during the procedure.
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