Open AccessUnexpected challenging case of coronary sinus lead extraction
Author(s) -
Luca Bontempi,
Donatella Tempio,
Raffaella De Vito,
Manuel Cerini,
Francesca Salghetti,
Niccolò Dasseni,
Clara Villa,
Abdallah Raweh,
Lorenza Inama,
Francesca Vassanelli,
Mario Luzi,
Antonio Curnis
Publication year - 2017
Publication title -
world journal of clinical cases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.368
H-Index - 10
ISSN - 2307-8960
DOI - 10.12998/wjcc.v5.i2.46
Subject(s) - medicine , coronary sinus , stylet , lead (geology) , ostium , implant , surgery , cardiac resynchronization therapy , extraction (chemistry) , cardiology , heart failure , chemistry , ejection fraction , chromatography , geomorphology , geology
An 84-year-old woman implanted with cardiac resynchronization therapy defibrillator underwent transvenous lead extraction 4 mo after the implant due to pocket infection. Atrial and right ventricular leads were easily extracted, while the attempt to remove the coronary sinus (CS) lead was unsuccessful. A few weeks later a new extraction procedure was performed in our center. A stepwise approach was used. Firstly, manual traction was unsuccessfully attempted, even with proper-sized locking stylet. Secondly, mechanical dilatation was used with a single inner sheath placed close to the CS ostium. Finally, a modified sub-selector sheath was successfully advanced over the electrode until it was free of the binding tissue. The post-extraction lead examination showed an unexpected fibrosis around the tip. No complications occurred during the postoperative course. Fibrous adhesions could be found in CS leads recently implanted requiring non-standard techniques for its transvenous extraction.