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J Thorac Cardiovasc Surg 2005;129:675-676
© 2005 The American Association for Thoracic Surgery

Brief Communications

Internal thoracic artery injury after transvenous pacemaker implantation

Alan P. Kypson, MDa,*, David W. Frazier, MDb, Jon F. Moran, MDa

a Division of Cardiothoracic Surgery, The Brody School of Medicine, East Carolina University
b Division of Cardiology, Pitt County Memorial Hospital, Greenville, NC

Received for publication June 28, 2004; revisions received July 7, 2004; accepted for publication July 13, 2004.

* Address for reprints: Alan P. Kypson, MD, Division of Cardiothoracic Surgery, The Brody School of Medicine, Room 252, East Carolina University, 600 Moye Blvd, Greenville, NC 27858 (E-mail: kypsona@mail.ecu.edu).

The first 20% of the full text of this article appears below.

Injuries associated with transvenous insertion of pacemaker leads occur infrequently. Common complications include pneumothorax-hemothorax, subclavian vein and artery injury, and myocardial perforation.1 We describe, for the first time, a laceration of the left internal thoracic artery (LITA) diagnosed 2 days after pacemaker implantation.


   Clinical summary
 
A 71-year-old man with a medical history significant for sick sinus syndrome and atrioventricular nodal conduction system disease underwent an insertion of a dual-chambered pacemaker. Screw-in pacing leads were placed transvenously and fixed in the right atrial appendage and right midventricular septum. The generator was implanted in a subcutaneous pocket in the left side of the chest. Pacing thresholds were adequate. Chest radiography revealed both leads to be in good position. The patient was discharged home the next day.

Thirty-six hours later, the patient presented in respiratory distress with left-sided chest pain. Initial systolic blood pressure was 70 mm Hg. Hemoglobin was 10.1 g/dL. Cardiac enzymes were within normal limits. Chest radiography . . . [Full Text of this Article]






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