Left minithoracotomy approach for repairing right ventricular perforation caused by temporary pacing catheterization: two case reports

BACKGROUND: Pacing catheter-induced right ventricular (RV) perforation is a rare, life-threatening complication. Its surgical procedure typically involves lead extraction and perforation site repair via a median sternotomy. Recently, a minimally invasive approach via a minithoracotomy has been the alternative feasible approach to cardiac surgery; it reportedly prevents sternotomy-related morbidities or offers favorable cosmetic results. Herein, we present two cases in which a temporary pacing catheter-induced RV perforation was repaired via left minithoractomy. CASE 1: An 84-year-old female was admitted with a complete atrioventricular block, which was then treated by temporary pacing catheterization. Two days later, the pacing failed. Computed tomography and echocardiography revealed that the temporary pacing catheter migrated and penetrated the RV apex without pericardial effusion. Subsequently, we repaired the perforation via a left minithoracotomy through the left sixth intercostal space. Intraoperatively, a hematoma was detected on the RV apex, with the penetrated catheter covered by the epicardium. After removing the pacing catheter, we achieved hemostasis by using sheet-type hemostatic agents. CASE 2: A 91-year-old female developed a complete atrioventricular block following transcatheter aortic valve implantation. She then underwent temporary pacing catheterization. Two days postoperatively, the pacing failed because the catheter was dislocated, as confirmed by chest X-ray. Computed tomography also revealed RV perforation apparently. Meanwhile, the fixing sutures of the pacing catheter were loose. She then underwent RV repair via a left minithoracotomy in the same fashion as that of case 1. The pacing catheter perforated the RV apex apparently, with bloody pericardial effusion. After removing the pacing catheter percutaneously, we repaired the perforation site through mattress suturing. CONCLUSIONS: Two patients with RV perforation caused by temporary pacing catheterization with stable hemodynamics were successfully treated by a left minithoracotomy.