P414 AN UNLUCKY CASE OF PNEUMOTHORAX AND CARDIAC PERFORATION

Abstract Background pacemaker (PMK) implantation is a routinary procedure although it isn’t free from complications, some of with could be life–treathing. Case report: A female 84 years old hypertensive cardiomiopathy and atrial fibrillation on anticoagulation theraphy Dabigatran was subjected (29th Sept) for sick sinus syndrome (SSS) after syncope. The day the chest radiography showed left–apical pneumothorax (PNX) without necessity surgical drain (fig. 1). Few days (3th Oct) patient dyspnoea, desaturation pain left hemithorax so CT performed detection massive hydropneumothorax needed drain. After 5 check (9th showing resolution PNX but documented circumferential 30 mm pericardial effusion “worthy cardiological reevalutation” meanwhile hemodynamically stable. At echocardiographic look there 15 mm. re–evalutation imeges by cardiologist, in suspicion myocardial perforation, were centralized cardio–surgery center. Transesophageal echocardiography evidenced 19 initial signs haemodynamic impact visualization lead percardual sac underwent (11th extraction ventricular median sternotomy epicardial reimplantation hybrid arrhythmological cardiosurgery operating theater. Conclusions cardiac perforation are two serious rare complication PMK an incidence 0,1% 1%, only anecdotally described together literature. finding which attributed syntomatology confounding factor that delay diagnosis miocardial perforation. unavailability programmer interrogating device didn’t allow early documentatio alteration electrical parameters. In first 3th Oct no reported but, retrospective analysis images alredy suggestive while they leave doubts second radiological examination (fig 2,3).