[HSF] Occluded SVC

[Ani Anyanwu]

Hal
 
What was the indication for the pacemaker? Could it be explanted now or is patient dependent on it?
 
Ani
 
 



> Date: Fri, 1 Feb 2008 08:55:41 -0500> From: jpym at erols.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Occluded SVC> CC: > > Hal> > I agree with those who advise anticoagulation and waiting for the clot to> lyse (most likely) or for further venous collaterals to form. The important> point is that the patient does not have a full-blown SVC syndrome and is> therefore unlikely to deteriorate from this point of view - he already has> collaterals.> > Another significant consideration is the fate of the pacing wires. What if> the leads become infected or the pacemaker erodes or the RV lead needs to be> extracted to provide venous access for an ICD lead (not uncommon in this day> and age)? You would be looking at a very unpleasant open redo if the> leads are locked in place by a stent.> > John Pym> > On Jan 31, 2008 7:11 AM, <Hgrmd at aol.com> wrote:> > > Dear Members,> > First, it was such a pleasure to meet several of you for the first time> > at> > the HSF dinner.> > I need some urgent advice. About 2 weeks ago, I did a redo AVR, mitral> > repair, tricuspid repair, Cox-maze on a 75 yo man. Intraop, while> > retracting> > the atrial septum for the work in the LA, noncircumferential intimal> > tears> > developed on both the SVC and IVC. I could tell because there was> > substantial> > venous blood coming from underneath the SVC and IVC. I was able to> > repair> > both with external suturing. The rest of the case went well. About a> > week> > later, we inserted a DDD pacemaker (the patient had been in continuous AF> > for> > years). A few days later, he developed severe facial and upper extremity> > swelling. Workup reveals he has an occluded SVC. The cardiologist took> > him to the> > lab and measured a 30 mm gradient across the SVC. The patient is> > ambulating> > well and generally feels OK, but he has the persistent swelling. There> > is> > no evidence of symptomatic intracranial swelling or upper airway> > compromise.> > The cardiologist insists something must be done. I'm reluctant to have a> > stent deployed in a fresh heart. The surgical option would be to extract> > the> > thrombus on CPB and patch the SVC. My question is: Is it justified?> >> > Hal> >> >> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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