A lead extraction procedure commenced to remove right atrial (ra), right ventricular (rv) and left ventricular (lv) leads due to bacteremia.A 2 cm vegetation was noted to be present on the rv lead.Spectranetics lead locking devices (llds) were inserted into each of the leads to provide traction.The physician began by using a spectranetics 14f glidelight laser sheath, and successfully extracted the ra and lv leads.While working to extract the rv lead and before the glidelight device reached the area of the superior vena cava (svc)/ra junction, the patient's blood pressure dropped.A pericardial effusion was detected via transesophageal echocardiography (tee).Rescue efforts commenced immediately including use of a rescue balloon, cpr (cpr may have migrated the position of the balloon within the vasculature), and pericardiocentesis.Surgeon was contacted but was delayed.Sternotomy and bypass were performed; approximately 8-10 minutes passed between initial blood pressure drop and sternotomy.A 2 mm svc/ra junction perforation was discovered.Repair took 45 minutes and was successful; however, patient had gone too long with no blood volume and the patient died.The physician felt the perforation was due to traction forces, since the glidelight device did not reach the svc/ra junction when removing the rv lead.This report captures the lld providing traction to the rv lead when the svc/ra perforation occurred.There was no alleged malfunction of any spectranetics devices in use during the procedure.
|