| A Case of Myocardial Lead Fixation
via a Small Costal Bed Thoracotomy Approach under Local Anesthesia |
(Department of Cardiovascular Surgery, Shiga National
Hospital, Yokaichi, Japan and Department of Cardiovascular Surgery,
Kyoto Second Red Cross Hospital*, Kyoto, Japan)
| Satoru Okumura |
Yoshinobu Maeda* |
Jun Okawara |
|
The patient was an 86-year-old man,
whose medical history included pulmonary tuberculosis, pulmonary
emphysema, hypothyroidism, subtotal gastrectomy for gastric cancer
and proctectomy for rectal cancer. Since he suffered sick sinus
syndrome (bradycardia-tachycardia syndrome), a DDD pacemaker
was implanted using the right subclavian vein approach. Three
months later, he suffered from a pacemaker infection of Methicillin-resistant
Staphylococcus aureus. We performed extraction of the
infected pacemaker system and implanted a new pacemaker. Because
he had thoracic deformity, colostomy, and was in poor condition
in general, we implanted the myocardial electrode through a small
thoracotomy at the 6th costal bed under local anesthesia. The
postoperative course was uneventful and there was no relapse
of infection. Although this method is conventionally performed
under general anesthesia, it is also possible to perform it under
local anesthesia in selected patients. This method could be an
alternative when endocardial electrode insertion is very difficult.
Jpn. J. Cardiovasc. Surg. 33: 255-258 (2004) |
|
