Unusual cause of hypoxemia after automatic implantable cardioverter‑defibrillatorleads extraction.
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Date
2015-10
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Abstract
The indication of pacemaker/AICD removal are numerous. Serious complication can occur during their
removal, severe tricuspid regurgitation is one of the complication. The occurrence of PFO is not uncommon
among adult population. Shunting across PFO in most circumstance is negligible, but in some necessitates
closure due to hypoxemia. We report a case of 62 year old man, while undergoing AICD removal, had
an emergency sternotomy for cardiac tamponade. Postoperatively, he experienced profound hypoxemia
refractory to oxygen therapy. Transthoracic Echocardiogram was performed to rule out intracardiac shunts
at an early stage, but it was difficult to obtain an good imaging windows poststernotomy. A small pulmonary
emboli was noted on CTPA, but was not sufficient to account for the level of hypoxemia and did not resolve
with anticoagulation. Transesophageal echocardiogram showed flail septal tricuspid valve with severe TR
and bidirectional shunt through large PFO. Patient was posted for surgery, tricuspid valve was replaced
and PFO surgically closed. Subsequently, patient recovered well ad was discharged to home. Cause of
hypoxemia might be due to respiratory or cardiac dysfunction. But for hypoxemia refractory to oxygen therapy,
transoesophageal echocardiogram should be always considered and performed early as an diagnostic tool
in post cardiac surgical patients.
Description
Keywords
Automatic implantable cardioverter‑defibrillator, Hypoxemia, Transesophageal echocardiogram, Patent foramen ovale, Tricuspid regurgitation
Citation
Raju Dinesh, Roysam Chandrika, Singh Rajendra, Clark Stephen C, Plummer Christopher. Unusual cause of hypoxemia after automatic implantable cardioverter‑defibrillatorleads extraction. Annals of Cardiac Anaesthesia. 2015 Oct; 18(4): 599-602.