Journal of Yeungnam Medical Science

Case report

Pediatrics, Perinatology, and Child Health
Unusual presentation of asymptomatic subacute lead-related ventricular perforation beyond the pericardium without pericardial effusion: a case report: Jihee Son, Lae-Young Jung; J Yeungnam Med Sci. 2023;40(Suppl):S105-S108. Published online May 31, 2023; DOI: https://doi.org/10.12701/jyms.2023.00171

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The clinical manifestations of subacute pacemaker lead-related cardiac perforations are highly variable. Patients with subacute perforations can present with a variety of symptoms, whereas those with acute perforations usually present with cardiac tamponade that necessitates emergent pericardiocentesis. A 32-year-old woman underwent pacemaker implantation for sick sinus syndrome. An active-fixation atrial lead was fixed to the right atrial appendage, and a ventricular lead was fixed to the right ventricle (RV) apex, with acceptable parameters. Two weeks postoperative, the patient visited the clinic for routine examination of the pacemaker parameters. Chest X-ray showed migration of the RV lead beyond the cardiac silhouette. Echocardiography revealed no evidence of pericardial effusion or tamponade. Computed tomography revealed that the RV lead was positioned beyond the RV and pericardium and into the anterior chest wall. Procedural lead revision was performed with cardiothoracic surgery backup. The lead was retracted after loosening the active-fixation screw and inserting the stylet. The lead was placed in the RV septum with active fixation. The procedure was completed without complications, and the patient was discharged after 3 days. Subacute lead perforations can present with various symptoms, and some patients may be asymptomatic without pericardial effusion. Altered lead parameters frequently provide the first indication for the diagnosis of cardiac perforation. Transvenous lead revision with surgical backup is an alternative to surgical extraction.

Citations

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Apical Lead Position Increases the Risk of Right Ventricular Lead Perforation: A Retrospective Cohort Study
Yuji Manabe, Tabito Kino, Shunichi Asano, Tomoyuki Fukuzawa, Shingo Tanaka, Jun Osada, Shinya Kowase, Hajime Aoki, Kazuhiko Yumoto
Pacing and Clinical Electrophysiology.2026;[Epub] CrossRef
Right ventricular lead migration to the abdominal cavity: a case report of an unexpected journey
Ibrahim Antoun, Ayman Helal, Azhar Farooqui, Mohsin Farooq, Mohammad El-Din, Bogdan Enache, Sebastian Feickert, Laura Rottner, Nicolo Sisti
European Heart Journal - Case Reports.2025;[Epub] CrossRef
A Shocking Complication: Right Ventricular Pacemaker Lead Perforation Presenting With Intractable Hiccups
Jeremy M Williams, Melville C O'Brien, Pramod Reddy
Cureus.2025;[Epub] CrossRef

Case Report

Physical therapy, Sports Therapy, and Rehabilitation
Visual recovery demonstrated by functional MRI and diffusion tensor tractography in bilateral occipital lobe infarction.: Jeong Pyo Seo, Sung Ho Jang; Yeungnam Univ J Med. 2014;31(2):152-156. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.152

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Abstract PDF

We report on a patient who showed visual recovery following bilateral occipital lobe infarct, as evaluated by follow up functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT). A 56-year-old female patient exhibited severe visual impairment since onset of the cerebral infarct in the bilateral occipital lobes. The patient complained that she could not see anything, although the central part of the visual field remained dimly at 1 week after onset. However, her visual function has shown improvement with time. As a result, at 5 weeks after onset, she notified that her visual field and visual acuity had improved. fMRI and DTT were acquired at 1 week and 4 weeks after onset, using a 1.5-T Philips Gyroscan Intera. The fiber number of left optic radiation (OR) increased from 257 (1-week) to 353 (4-week), although the fiber numbers for right OR were similar. No activation in the occipital lobe was observed on 1-week fMRI. By contrast, activation of the visual cortex, including the bilateral primary visual cortex, was observed on 4-week fMRI. We demonstrated visual recovery in this patient in terms of the changes observed on DTT and fMRI. It appears that the recovery of the left OR was attributed more to resolution of local factors, such as peri-infarct edema, than brain plasticity.

Citations

Citations to this article as recorded by

Diffusion Tensor Imaging Studies on Recovery of Injured Optic Radiation: A Minireview
Eun Bi Choi, Sung Ho Jang
Neural Plasticity.2020; 2020: 1. CrossRef

Original Article

Nephrology
The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients.: Jun Beom Park, Jung Mee Kim, Jun Hyuk Choi, Kyu Hyang Jo, Hang Jae Jung, Yeung Jin Kim, Jun Yeung Do, Kyung Woo Yoon; Yeungnam Univ J Med. 1999;16(2):347-356. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.347

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Abstract PDF: BACKGROUND
Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

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