University Clinic surgeons perform another complex heart procedure
A nonstandard pacemaker implantation was completed for a 75-year-old male patient.
He was hospitalized with bradycardia, vertigo, and unstable consciousness. The surgeons decided to perform a standard implantation via endovascular technique.
“However, during the first stage of the intervention, doctors encountered an extremely rare pathology, occurring in less than 0.1 percent of cases. All of the major veins used to route electrodes to the heart (subclavian, femoral, and jugular) in the patient were obstructed.,” notes Head of Surgery Department #3 Anton Omelyanenko.
CT scan showed occlusions of central veins, and venous outflow carried out through a developed network of subcutaneous collateral vessels of the chest. These vessels connected with the superior vena cava system only in the sternum area.
“Interestingly, with such serious anatomical changes, the patient didn’t exhibit any external signs of pathology, such as edema. This made the case especially diffuclt,” adds cardiologist Aliya Nasibullina.
A panel decided to perform epicardial pacing, a technique in which electrodes are attached directly to the outer surface of the heart. This approach is extremely rare and is reserved for cases where standard endovascular access is impossible.
“The situation was complicated by the patient’s inflammatory pericardial disease: the heart membrane was tightly fused to the myocardium, significantly increasing the technical complexity of the surgery,” says cardiovascular surgeon Timur Mavlyudov.
Cardiovascular surgeon Albert Khafizov notes that, despite all the difficulties, the surgical team managed to successfully implant electrodes in the right atrium and right ventricle through a small left-sided access, providing full dual-chamber pacing.
Dr Omelyanenko emphasizes that in such cases, cardiac surgeons often limit themselves to single-chamber pacing to reduce risks. However, dual-chamber pacing allows for more physiological cardiac function and significantly improves the patient’s quality of life.
“The use of a modern technique is particularly noteworthy. The clinic’s specialists perform vein punctures under ultrasound guidance without a preliminary skin incision. This approach minimizes tissue trauma and promptly identifies anatomical features,” he concludes.
The patient’s condition is currently stable. He has been discharged for outpatient observation.