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Case Reports
. 2021 Jul 9;25(1):26-29.
doi: 10.1016/j.jccase.2021.06.009. eCollection 2022 Jan.

Inadvertent left ventricular placement of ICD lead through the left subclavian artery right positioned in a patient with situs viscerum inversus and Kartagener syndrome

Domenico Carretta  1 , Maria Castellano  1 , Domenico Gianfrancesco  2 , Lucrezia De Michele  1 , Monica Cozzolino  3 , Pasquale Pedote  3 , Domenico Angiletta  4 , Raffaele Pulli  4 , Paolo Colonna  1 , Carlo D'Agostino  1
Affiliations
Case Reports

Inadvertent left ventricular placement of ICD lead through the left subclavian artery right positioned in a patient with situs viscerum inversus and Kartagener syndrome

Domenico Carretta et al. J Cardiol Cases. .

Abstract

Inadvertent placement of pacemaker and implantable cardioverter-defibrillator (ICD) leads in the left ventricle is a rare but well-recognized complication of device implantation. We report a case of an unicameral ICD lead inadvertently placed through the left subclavian artery right positioned, across the aortic valve into the left ventricle, in a patient with situs viscerum inversus. A transthoracic echocardiogram about a month after the procedure showed an unusual course of the lead. The lead was successfully removed without complications or sequelae. <Learning objective: Subclavian artery accidental puncture during pacemaker / implantable cardioverter-defibrillator implantation is an important complication. With grown up congenital heart this complication could occur more frequently and with more serious complications if the patient's anatomy is not well framed and deepened by specific instrumental examinations. If the above complication is managed quickly and competently and if the artery is not instrumented, it does not cause serious consequences.>.

Keywords: Echocardiography; Grown Up Congenital Heart Disease (GUCH); Lead malposition; Percutaneous lead extraction.

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Figures

Fig. 1
Fig. 1
Transthoracic echocardiography images showing implantable cardioverter-defibrillator (ICD) catheter course. (A) It passes between the right and the non-coronary aortic cusps (arrow) and continues in the left ventricle by lying on the antero-lateral wall and reaching the apex. (B) Upper left the continuous wave Doppler and color Doppler show aortic regurgitation, secondary to ICD lead; in the other images the intra left ventricular course of ICD lead is indicated by arrows. Ao, aorta; LA, left atrium; LV, left ventricle.
Fig. 2
Fig. 2
(A) Axial computed tomography (CT) scan with contrast agent showing the implantable cardioverter-defibrillator (yellow arrow), the subclavian vein (blue arrow) and the subclavian artery (red arrow). (B) Axial CT scan at an immediately more caudal level shows the electrode access in the subclavian artery (red arrow). (C) Coronal maximum intensity projection reconstruction showing the electrode course from the subclavian artery (orange arrow) to the aortic arch and in the left ventricle. (D) Curve reconstruction on the coronal plane that shows the entire course of the electrode.
Fig. 3
Fig. 3
Fluoroscopic images. Left panel: lead course in the subclavian artery before the extraction; a temporary back-up pacemaker lead is visible. Middle panel: the covered stent sheath is visible (black arrow), crossing the implantable cardioverter-defibrillator coil (white arrow) at the point of the extraction. Right panel: after removal of the lead, the covered stent graft implanted to close the lead tear is visible (black arrow).
See this image and copyright information in PMC

References

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