title: Late right ventricular perforation and hemothorax after transvenous defibrillator lead implantation.
abstract: A 53-year-old man with ischemic cardiomyopathy underwent prophylactic transvenous implantable cardioverter-defibrillator (ICD) placement. Nine days after the procedure, he had recurrent chest pain and left pleural effusion associated with a drop in hemoglobin. Hemothorax and right ventricular (RV) lead perforation were suspected on chest radiography and lead interrogation, and confirmed by thoracentesis and contrast computed tomography (CT) scanning, respectively. The CT-scan clearly demonstrated the RV lead tip projecting beyond the cardiac border into the anterior left pleural space. The perforated lead was removed in the operating room under transesophageal echocardiography guidance and a new transvenous lead was successfully placed a month later. This case highlights: 1) the importance of suspecting late RV perforation in patients with ICD implantation presenting with recurrent chest pain and/or pleural effusion; 2) the value of CT in its diagnosis; and 3) the need for a more careful management of this potentially life threatening complication.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch, Galveston, Texas USA.
authors.forename: Ramanna
authors.initials: R
authors.lastname: Merla
authors.forename: Nischita K
authors.initials: NK
authors.lastname: Reddy
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kunapuli
authors.forename: Ernst
authors.initials: E
authors.lastname: Schwarz
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rosanio
mesh_terms: D002637:Chest Pain / Q000209:etiology; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D014947:Wounds and Injuries / Q000209:etiology / Q000473:pathology