Unusual cause of hypoxemia after automatic implantable cardioverter-defibrillatorleads extraction

Raju, Dinesh, Roysam, Chandrika, Singh, Rajendra, Clark, Stephen and Plummer, Christopher (2015) Unusual cause of hypoxemia after automatic implantable cardioverter-defibrillatorleads extraction. Annals of Cardiac Anaesthesia, 18 (4). pp. 599-602. ISSN 0971-9784

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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.

Item Type:	Article
Uncontrolled Keywords:	Automatic implantable cardioverter-defibrillator; Hypoxemia; Transesophageal echocardiogram; Patent foramen ovale; Tricuspid regurgitation
Subjects:	A300 Clinical Medicine B100 Anatomy, Physiology and Pathology
Department:	Faculties > Health and Life Sciences > Applied Sciences
Depositing User:	Becky Skoyles
Date Deposited:	29 Nov 2017 12:17
Last Modified:	12 Oct 2019 12:03
URI:	http://nrl.northumbria.ac.uk/id/eprint/32690

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