Pacemaker-Associated Thrombotic Occlusion of the Inferior Vena Cava Causing Liver Failure

Abstract

Pacemaker implantation using endocardial leads can give rise to thrombotic venous occlusion. We report the case of a 23-year-old male with transposition of the great arteries, who had previously undergone a Senning repair at the age of one year. A sick sinus syndrome required pacemaker implantation with subsequent multiple lead revisions. Following the implantation of the last lead, the patient developed complete occlusion of the inferior vena cava (IVC) with stenosis of the superior vena cava (SVC) with pacemaker leads in both lesions. Liver failure, ascites and esophageal varices developed. Thrombolytic treatment was ineffective; finally the patient was listed for liver transplantation. We explanted the lead embedding the thrombosis, together with some lead remnants. The stenosis of the SVC and the occlusion of the IVC were dilatated and stabilized with four stents. Over a follow-up period of 4 months, NYHA class improved from NYHA III to NYHA I–II, the hepatic function showed complete remission, and a liver transplantation was not necessary.

Key words

Cardiovascular surgery - cardiomyopathy - heart disease

References

• 1 Hoffman J I, Kaplan S. The incidence of congenital heart disease.  J Am Coll Cardiol. 2002;  39 1890-1900
• 2 Warnes C A. Transposition of the great arteries.  Circulation. 2006;  114 2699-2709
• 3 Senning A. Surgical correction of transposition of the great arteries.  Surgery. 1959;  45 966-980
• 4 Mustard W T. Successful two-stage correction of transposition of the great arteries.  Surgery. 1964;  55 469-472
• 5 Blalock A, Hanlon C R. Surgical treatment of complete transposition of aorta and pulmonary artery.  Surg Gynecol Obstet. 1950;  90 1-15
• 6 Rashkind W J, Miller W W. Creation of an atrial septal defect without thoracotomy: a palliative approach to complete transposition of the great arteries.  JAMA. 1966;  196 991-992
• 7 Dos L, Teruel L, Ferreira I J, Rodriguez-Larrea J, Miro L, Girona J, Albert D C et al. Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries.  Heart. 2005;  91 652-656
• 8 Spittell P C, Hayes D L. Venous complications after insertion of a transvenous pacemaker.  Mayo Clin Proc. 1992;  67 (3) 258-265
• 9 Khairy P, Landzberg M J, Gatzoulis M A, Mercier L A, Fernandes S M, Côté J M, Lavoie J P et al. Transvenous pacing leads and systemic thrombemboli in patients with intracardiac shunts: a multicenter study (EVENT study).  Circulation. 2006;  113 2391-2397
• 10 Sachweh J S, Vazquez-Jimenez J F, Schöndube F A, Daebritz S H, Dörge H, Mühler E G, Messmer B J. Twenty years experience with pediatric pacing: epicardial and transvenous stimulation.  Eur J Cardiothorac Surg. 2000;  17 (4) 455-461