Multiple systemic emboli complicating the course of a patient with an atrial septal defect, an atrial septal aneurysm and an endocardial right atrial pacemaker lead.
We describe an adult patient with a large atrial septal defect, an atrial septal aneurysm and thrombus formation on a transvenous right atrial pacing lead. Because of right-to-left shunting through the atrial septal defect, she developed multiple systemic emboli to the spleen and left kidney (with infarcts), to the left leg, and probably to the brain as a cerebrovascular accident. The fundamental guiding principle of avoiding endocardial pacing leads in patients with congenital intracardiac communications, was violated in this patient, leading to serious dire consequences and complications.
Johnson
C
C
Department of Medicine, University of Puerto Rico, School of Medicine, San Juan, PR 00936-5067.
Galindez
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L
D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications*; D006343:Heart Septal Defects / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007238:Infarction / Q000209:etiology; D007668:Kidney / Q000098:blood supply; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013159:Splenic Infarction / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed