2020 Volume 24 Issue 1 Pages 173-177
In this report, we describe the case of a patient with a massive primary cardiac malignant lymphoma who underwent anesthetic management for transvenous pacemaker implantation, which was safely performed using combined transesophageal echocardiography (TEE) and fluoroscopy intraoperatively with pacing lead placement guided by echocardiography.
A 71 year-old male was diagnosed with a massive cardiac malignant lymphoma. The tumor occupied the right atrium and ventricle, as well as the vena cava. Electrocardiography revealed a complete atrioventricular block. Elective pacemaker implantation under general anesthesia was planned. General anesthesia was carefully introduced with extracorporeal circulation on stand-by in case of collapsed circulation.
Intraoperatively, guiding the pacing lead to the proper position was difficult for the cardiovascular surgeon. The anesthesiologist then suggested the use of TEE for guiding the pacing lead. Subsequently, the pacing lead was successfully placed in the appropriate position by a combination of TEE guidance and fluoroscopy without any cardiovascular complications.
TEE guidance may be considered feasible and efficient for transvenous pacemaker implantation under general anesthesia.
