Cardiac Strangulation in Children: Asymptomatic Complication of Epicardial Pacing

Abstract

Cardiac strangulation is a rare but potentially life-threatening mechanical complication associated with epicardial pacemaker implantation in growing children. This article presents 2 case reports of left ventricular strangulation in 4- and 3-year-old children who had an epicardial pacemaker system implanted at an early age. (Level of Difficulty: Advanced.).

Keywords: CHB, complete heart block; CS, cardiac strangulation; DDDR, dual chamber rate adaptive pacing mode; ECG, electrocardiogram; LV, left ventricle; RA, right atrium; cardiac pacing; complication; pediatric surgery.

Graphical abstract

Figure 1

First Patient (A) Echocardiography: left ventricle (LV) geometry is damaged (“hourglass head”). (B) Lateral view of the x-ray. The pacemaker lead was completely wrapped around the cardiac silhouette. (C) Left ventriculography showing deformation of LV contour in the apex view. (D) Lateral view of the postoperative x-ray showing the leads well placed at the bottom of the pericardium. LA = left atrium.

Figure 2

Electrocardiogram (A) The first case. (B) The second case. Pacing in DDD mode. P = synchronized ventricular pacing.

Figure 3

Strangulation Groove From the Loop of the Atrial Epicardial Lead LV = left ventricle; SG = strangulation groove.

Figure 4

Second Patient (A) Frontal view of the x-ray. (B) Lateral view of the c-ray confirming the diagnosis of cardiac strangulation showing a classic pattern of looping. (C) Computed tomography with intravenous bolus contrast confirming a loop around the heart; the conflicts with heart structures and vessels were not detected. The frontal view shows the epicardial leads looping left ventricle. (D) The lateral view shows the leads looping left ventricle.