Pneumopericardium and Pneumomediastinum as a Late Complication of Defibrillator Implantation after Coronary Artery Bypass Graft Surgery

Abstract

A 69-year-old male underwent implantation of a cardioverter-defibrillator with cardiac resynchronization therapy (CRT) for symptomatic ventricular tachyarrhythmia (VT) and severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 30 % and dyssynchrony via a left subclavian venous access. Twenty days after the procedure, the patient complained of shortness of breath and was found to have a 30 % apical left pneumothorax on chest X‐ray as a not unusual complication of the subclavian venous access. A computed axial tomography of the chest revealed pneumopericardium and associated pneumomediastinum as a complication of the CRT implantation and persisting microscopic pleuro-pericardial fistula as a consequence of previous coronary artery bypass graft surgery (CABG), accidentally diagnosed three years after the procedure. The pneumothorax and pneumopericardium were small and did not require chest tube placement. The patient was treated conservatively and his subsequent course was excellent.

Key words

Pneumothorax - pneumopericardium - pneumomediastinum - cardiac resynchronization therapy - pleuro‐pericardial fistula

References

• 1 Aggarwal R K, Connelly D T, Ray S G, Ball J, Charles R G. Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems.  Br Heart J. 1995;  73 571-575
• 2 Ho W J, Kuo C T, Lin K H. Right pneumothorax resulting from an endocardial screw-in atrial lead.  Chest. 1999;  116 1133-1134
• 3 Gondi B, Nanda N C. Real-time, two-dimensional echocardiographic features of pacemaker perforation.  Circulation. 1981;  64 97-106
• 4 Deanfield J, Jonathan A, Fox K. Pericardial complications of endocardial and epicardial pacing.  Br Med J (Clin Res Ed). 1981;  283 635-636