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Abstract
Background A 31 year old male with a history of Senning repair for transposition of the great arteries, coarctation repair and conduction system disease with right pre-pectoral single chamber PPM implanted to sub-pulmonic left ventricle in 2009 presented with generator battery depletion. Attempts to replace the existing generator failed due to a damaged screw set, and antegrade implantation of a new system failed due to subclinical SVC obstruction.
Objective Implant a new system and avoid the need to perform lead extraction.
Methods N/A
Results Retrograde venoplasty to the SVC was performed via a right femoral vein (RFV) approach using a coronary angioplasty wire and serial balloon inflation up to 4.5mm with compliant and non-compliant balloons. This allowed delivery of a guide extension catheter beyond the occluded segment and the wire was up-sized to 0.035 guidewire. Concurrent access was obtained via the right subclavian vein (RSV). The 0.035 guidewire from the RFV was snared from the RSV and externalized, and a stiffer guidewire exchanged. A long 7Fr ARROW sheath was passed over the wire from the RSV, a second stiff guidewire was added, and an IMA catheter was passed over this wire through the baffle to allow a SAFARI wire to be safely placed within the sub-pulmonic ventricle. This allowed the sheath to be safely exchanged for a long 7Fr peel-away sheath directly into the sub-pulmonic ventricle to deliver a pacing electrode. This was connected to a new generator.
Conclusion The old generator was cut from the old lead and the exposed end capped. The patient was discharged the next day. Cross-pollination between cardiology sub-specialties will likely become more common during complex procedures.
Conflict of Interest None