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Rof á hjarta eftir gangráðsísetningu - íslensk tilfellaröð.

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Authors
Ingvar Þ Sverrisson
Jón Högnason
Halla Viðarsdóttir
Gizur Gottskálksson
Gunnar Þór Gunnarsson
Jón Þór Sverrisson
Tómas Guðbjartsson
Útgáfudagur
2013-04

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Önnur málmynd
Cardiac perforation following pacemaker implantation - a case series from Iceland.
Citation
Læknablaðið 2013, 99(4):183-6
Útdráttur
Einn alvarlegasti fylgikvilli við gangráðsísetningu er þegar gangráðsvír rýfur gat á hjartað sem getur orsakað lífshættulega blæðingu. Lýst er 5 tilfellum sem greindust hér á landi á fjögurra ára tímabili. Farið var yfir sjúkraskrár allra sjúklinga sem greindust með rof á hjarta eftir gangráðsísetningu á Landspítala og Sjúkrahúsi Akureyrar frá 1. janúar 2007 til 31. desember 2010. Könnuð var meðferð og afdrif þessara sjúklinga. Alls greindust 5 sjúklingar, þrjár konur og tveir karlar. Meðalaldur var 71 ár. Brjóstverkur var algengasta einkennið (n=4) en enginn sjúklinganna hafði einkenni um bráða hjartaþröng. Greining fékkst í öllum tilfellum með tölvusneiðmynd af brjóstholi eða ómskoðun af hjarta. Ekkert rof greindist við gangráðsísetningu en fjögur tilfelli greindust innan þriggja vikna eftir aðgerð. Hjá þremur sjúklinganna var blóð tæmt úr gollurshúsi í gegnum bringubeinsskurð, saumað yfir gatið og nýjum gangráðsvír komið fyrir. Hjá hinum tveimur voru gangráðsvírar dregnir án skurðaðgerðar og vélindaómun notuð til að fylgjast með blæðingu í gollurshús. Einn sjúklinganna lést á gjörgæslu vegna lungnabólgu en hinir fjórir lifðu fylgikvillann af og útskrifuðust af sjúkrahúsi. Rof á hjarta er hættulegur fylgikvilli sem mikilvægt er að hafa í huga hjá sjúklingum með brjóstverk eftir gangráðsísetningu.
Perforation of the heart is a serious complication following pacemaker implantation that can cause life threatening bleeding and cardiac tamponade. Here we describe five cases that were diagnosed in Iceland during a four year period. This population-based case series includes five patients diagnosed with cardiac perforation following pacemaker insertion at Landspítali and Akureyri Hospital from January 1, 2007 to December 31, 2010. The mode of detection, treatment given and outcome were studied. Altogether five patients (mean age 71 years, three females) were diagnosed with cardiac perforation in Iceland during the study period, one in 2008 and four in 2009. Chest pain was the most common presenting symptom (n=4) and no patient had acute cardiac tamponade. In all five cases the diagnosis was obtained with computed tomography scan or echocardiography. No perforation was detected intraoperatively but four of the cases were diagnosed within three weeks of the operation. Three patients were treated with surgical evacuation of blood via sternotomy and suture of the perforation. In the other two cases the pacemaker leads were removed in the operating room with trans-oesophageal echocardiographic guidance. Four patients survived the treatment and were discharged but one died of pneumonia in the intensive care unit. Cardiac perforation is a serious complication and should be kept in mind in patients with chest pain following pacemaker insertion.
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http://www.laeknabladid.is
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Icelandic Journal Articles (Peer Reviewed)

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