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Ventricular perforation by a cardioverter lead in a small child

Published online by Cambridge University Press:  20 January 2005

Christian Schreiber ,
Jörg Hausleiter  and
Rüdiger Lange
Christian Schreiber
Affiliation:
Clinic of Cardiovascular Surgery at the Technical University, German Heart Center Munich, Germany
Jörg Hausleiter
Affiliation:
Department of Radiology, German Heart Center Munich, Germany
Rüdiger Lange
Affiliation:
Clinic of Cardiovascular Surgery at the Technical University, German Heart Center Munich, Germany
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Abstract

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Type
Images in Congenital Heart Disease
Information
Cardiology in the Young , Volume 14 , Issue 2 , April 2004 , pp. 197
Copyright
© 2004 Cambridge University Press

A 4-year-old girl was resuscitated after presenting with a history of ventricular fibrillation. Electrophysiological investigations were performed, and the suspected diagnosis of Brugada syndrome was confirmed by genetic linkage analysis. The Brugada syndrome is believed to be responsible for up to one-eighth of all sudden deaths. With this in mind, we implanted a single-coil defibrillation lead (Riata™, 1582, St. Jude Medical®; Saint Paul, USA), with its extendable helix. Follow-up in hopsital was uneventful. One month later, the girl presented with acute chest pain. Chest radiography (Fig. 1) revealed a markedly abnormal location of the lead, suggestive of right ventricular perforation. This was confirmed by three-dimensional reconstruction of images obtained using 16-slice spiral computed tomography (Fig. 2). After extraction of the lead, which resulted in moderate pericardial effusion, we inserted a passive fixation lead without any helix (Riata™, 1572). Such passive fixation of leads may be warranted in small children with thin-walled right ventricles.

Figure 1.

Figure 2.