title: Aortic perforation due to cardiac resynchronisation therapy defibrillator lead placement: Case report and medicolegal considerations.
abstract: A 45-year-old woman with dilated cardiomyopathy was admitted for the upgrade of a previously implanted pacemaker. Echocardiography showed intraventricular dyssynchrony and a low ejection fraction (0.35). Treatment with a cardiac resynchronization therapy defibrillator (CRT-D) was selected and the device was implanted. CRT-D interrogation revealed proper function. Following procedure termination, the patient went into cardiac arrest and died despite resuscitation attempts. An autopsy revealed that the medial aspect of the right atrium was pierced by an active lead and that the aorta had a deep lesion, 2 mm in length, on its lateral aspect. We explain the probable pathogenesis of this patient׳s death.
authors.affiliation: Divisione Cardiochirurgia IRCCS Policlinico San Matteo Pavia, Viale C. Golgi, 19, 27100 Pavia, Italy.
authors.forename: Antonino M
authors.initials: AM
authors.lastname: Grande
authors.affiliation: Divisione Cardiochirurgia IRCCS Policlinico San Matteo Pavia, Viale C. Golgi, 19, 27100 Pavia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiore
authors.affiliation: Istituto Medicina Legale Università degli Studi Pavia, Via C. Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Merlano
authors.affiliation: Istituto Medicina Legale Università degli Studi Pavia, Via C. Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Buzzi
authors.affiliation: Divisione Cardiochirurgia IRCCS Policlinico San Matteo Pavia, Viale C. Golgi, 19, 27100 Pavia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzola
keywords: Active lead; Aortic perforation; Cardiac resynchronization therapy defibrillator; Implantable cardioverter defibrillator