日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 37(1): 35-41 (2021)
doi:10.9794/jspccs.37.35

症例報告Case Report

心臓カテーテル検査中に想定外の心筋虚血から心停止に陥った心外膜リードによる心絞扼の1例Epicardial Pacemaker Lead-induced Cardiac Strangulation Causing Asystole due to Unexpected Myocardial Ischemia during Catheterization: A Case Report

1福岡市立こども病院 循環器科Department of Cardiology, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

2福岡市立こども病院 心臓血管外科Department of Cardiovascular Surgery, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

3福岡市立こども病院 放射線部Department of Radiology, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

受付日:2020年3月17日Received: March 17, 2020
受理日:2020年9月7日Accepted: September 7, 2020
発行日:2021年4月1日Published: April 1, 2021
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症例は1歳時に先天性完全房室ブロックに対しペースメーカー植込み術が行われた16歳男性で,9歳時より心外膜リードによる心絞扼と思われる肺動脈弁上狭窄がみられた.運動負荷試験では一過性のST変化が見られるのみで胸痛は誘発されず,心筋虚血は否定的と判断された.肺動脈弁上狭窄が進行し,手術適応の評価目的に心臓カテーテル検査を行った.左室造影前に上肢挙上の姿勢でテスト造影を行った直後,患者は突如意識消失を来した.発症時の心電図では心室性期外収縮の頻発後にST変化が出現し,急速に徐脈から心停止に至っていた.上肢挙上や期外収縮の頻発に伴い冠動脈が圧排され心筋虚血を来したと推察し,緊急手術によるリード交換を行った.心絞扼が疑われる症例では心臓CTにより冠動脈圧排の有無を確認し,突発的な心筋虚血の危険性を念頭に速やかなリード交換を検討すべきである.

A 16-year-old male with complete congenital atrioventricular block since 1 year old was treated by epicardial pacemaker lead implantation. At 9 years old, he was diagnosed with supravalvular pulmonary artery stenosis resulting from epicardial pacemaker leads with cardiac strangulation as the possible cause. Transient ST change was seen only in the exercise tolerance test, with no chest pain, indicating that myocardial ischemia was absent. The deterioration status of supravalvular pulmonary artery stenosis was assessed by catheterization. With his arms raised, he was injected with a small amount of contrast media, suddenly, he lost consciousness. Electrocardiography showed ST segment alterations after frequent premature ventricular contractions, followed by junctional bradycardia that rapidly progressed to asystole. Hence, transient ischemia caused by arm raising or frequent premature ventricular contractions and deterioration of the coronary artery compression was suspected. The leads were then removed in an urgent surgery. In conclusion, contrast-enhanced computed tomography should be conducted in patients with cardiac strangulation, and earlier lead exchange should be performed because of the rapid deterioration of myocardial ischemia.

Key words: cardiac strangulation; pacemaker; congenital complete atrioventricular block

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This page was last modified on 2021-04-15T08:46:54.000+09:00


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