Document Detail

Repeated massive pulmonary air embolism during pacemaker implantation.
MedLine Citation:
PMID:  23024126     Owner:  NLM     Status:  MEDLINE    
Pacemaker implantation is associated with the potential for various acute and late complications. Though they rarely occur, massive pulmonary air embolisms are lethal. We report the case of a 72-year old male with sick sinus syndrome who underwent permanent pacemaker implantation. Sedation was administered due to back pain with the resultant appearance of snoring. The procedure was complicated with repeated massive pulmonary air embolisms. The events occurred after the leads had been placed in the sheaths. The patient was successfully resuscitated with fluid challenge, O(2) supplement, vasopressor and catheter aspiration. This case illustrates that in a heavily sedated, snoring patient, the marked negative intrathoracic pressure can overcome the frictional resistance of air to being sucked into the gap between the lead body and sheath's wall. Careful manipulation alone is not enough to prevent pulmonary air embolisms. Aggressive treatment for upper airway obstruction is important. The use of a sheath with a haemostatic valve is strongly recommended if the upper airway obstruction cannot be treated adequately.
Bao-Tzung Wu; Ying-Tsung Chen
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2012-09-28
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-20     Completed Date:  2013-05-06     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1085-7     Citation Subset:  IM    
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MeSH Terms
Cardiac Surgical Procedures / adverse effects*,  instrumentation*
Deep Sedation*
Embolism, Air / diagnosis,  etiology*,  therapy
Fluid Therapy
Oxygen Inhalation Therapy
Pacemaker, Artificial*
Pulmonary Embolism / diagnosis,  etiology*,  therapy
Radiography, Interventional
Resuscitation / methods
Sick Sinus Syndrome / surgery*
Snoring / complications*
Treatment Outcome
Vasoconstrictor Agents / therapeutic use
Reg. No./Substance:
0/Vasoconstrictor Agents
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1087   [PMID:  23166222 ]
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1087   [PMID:  23166223 ]

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