Left Mini Thoracotomy as a Method for Epicardial Implantable Cardioverter-Defibrillator Placement in a Child. An Effecti
- PDF / 970,356 Bytes
- 2 Pages / 595.276 x 793.701 pts Page_size
- 38 Downloads / 152 Views
Hellenic Journal of Surgery (2020) 92:3-4, 141-142
Left Mini Thoracotomy as a Method for Epicardial Implantable Cardioverter-Defibrillator Placement in a Child. An Effective Alternative to the Transvenous Approach Kanakis M1, Tsoutsinos A1, Maounis T3, Bobos D1, Lioulias A4, Kousi T1, Alexiou K5, Giannopoulos N1
Abstract In infants and children, the small size of the systemic veins precludes safe and durable transvenous placement of automatic internal cardiac defibrillator (ICD). In such cases, an alternative method of implanting an automatic ICD is via thoracotomy. This report describes the technique used at Onassis Cardiac Surgery Center for the epicardial placement of an ICD system with a transvenous ICD coil placed in the posterior pericardium via a left thoracotomy, producing a stable location and excellent coil-to-can vector for successful defibrillation. To the best of our knowledge, this is the first case in Greece. Key words: Thoracotomy; epicardial; implantable; cardioverter; defibrillator; childhood; infancy
Introduction The prevention of sudden cardiac death resulting from malignant arrhythmias, hypertrophic cardiomyopathy often requires the implantation of automatic internal cardiac defibrillator (ICD) in the pediatric population. However, the small size of the systemic veins and the complex anatomy of potential congenital heart disease are significant factors that preclude the safe transvenous placement of the ICD coil. In these cases alternative techniques for ICD placement have been described such as epicardial placement via sternotomy or thoracotomy and subcutaneous implantation of defibrillator [1-3]. This report describes the technique used at Onassis Cardiac Surgery Center for the epicardial placement of an ICD system with a transvenous ICD coil placed in the posterior pericardium via a left thoracotomy, producing a stable location and excellent coil-to-can vector for successful defibrillation. To the best of our knowledge this is the first case in Greece.
Case Presentation A 3 ½-year-old boy with a history of cardiac arrest and malignant arrhythmias was referred to our hospital for ICD placement. Due to the age and BSA of the patient the deciDepartment of General Surgery, General Hospital of Drama, Greece Corresponding author: Meletios Kanakis Department of Pediatric and Congenital Heart Surgery, Onassion Cardiac Surgery Center, Athens, Greece Tel.: +30 6945 955085, e-mail: [email protected] Received Jun 1, 2020; Accepted Jun 10, 2020 Hellenic Journal of Surgery 92
sion was made to place the ICD by a surgical method. As transvenous coil and ICD were available for the patient, the decision was to proceed with the epicardial placement of the transvenous coil via a small left thoracotomy. The generator would be placed in the abdominal wall on the rectal sheath. In theatre, a 5cm left posterolateral thoracotomy was performed allowing entry of the thoracic cavity through the fourth intercostal space. The lung was retracted posteriorly and the pericardium was opened longitudinally in para
Data Loading...
