Intravenous pacemaker lead implantation for a pediatric patient: A 16-year follow-up study

Intravenous pacemaker lead implantation for small children is not performed routinely. Here, we report the case of a pediatric patient who underwent endocardial lead implantation and follow-up for 16 years. The patient was a 4-year-old boy who underwent total correction of pulmonary atresia with ventricular septal defect following several palliative operations. After the patient underwent total correction, atrial flutter was noted. Atrial flutter was successfully terminated by overdrive pacing. However, atrial flutter occurred again immediately after overdrive pacing. To treat atrial flutter caused by sick sinus syndrome, a screw-in type lead was attached to the free wall of the right atrium and an excess loop was left to allow for the patient's growth. During the 16-year follow-up, no adverse effects were observed except for a gradual increase in pacing threshold. The selection of a small-sized endocardial lead and an appropriate entry vein, with meticulous management of the leads, makes implantation of an endocardial lead for small children easier and safer

〈Case Reports〉Right atrial thrombus mimicking myxoma in antiphospholipid syndrome with secondary immune thrombocytopenic purpura

[Abstract]A 22-year-old woman was referred to our hospital due to a large right atrial mass. Echocardiography showed the mass to be pedunculated,mobile, partially calcified, internally heterogeneous,and with a rough surface. Computed tomography showed internal calcification and heterogeneity.On magnetic resonance imaging, the mass was isointense to hypointense on T1-weighted images and hypointense to hyperintense on T2-enhanced images. Simultaneously, laboratory work-up revealed antiphospholipid syndrome (APS) with secondary immune thrombocytopenic purpura (ITP). We could not definitively differentiate between myxoma or cardiac thrombus associated with APS. Preoperatively,the patient was administered γ-globulin and methylprednisolone due to ITP. Surgical resection of the mass was performed in order to avoid incarceration to the tricuspid valve or embolization. Based on gross and histologic findings, the cardiac mass was diagnosed as a thrombus. She was discharged with no postoperative bleeding. APS-associated cardiac thrombus is rare. It is difficult to distinguish APS-associated cardiac thrombus from myxoma. Moreover, ITP sometimes occurs as a complication in patients with APS. We experienced a case of right atrial thrombus mimicking myxoma in a patient with APS and secondary ITP