Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature.

AIMS: Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. METHODS AND RESULTS: The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. CONCLUSION: Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable.

Radial Artery Pseudoaneurysms Treated by Ultrasound-Guided Differential Compression: An Effective and Simple Method.

Transradial approach has become preferable to conventional femoral artery access for both diagnostic coronary angiography and percutaneous coronary intervention. A rare but recognizable complication of radial access is radial artery pseudoaneurysm (RAp), which represents a potentially catastrophic complication. Treatment options comprise ultrasound (USG)-guided manual compression or thrombin injection or surgical correction. In this case series, we report four cases of RAps that we encountered at a single tertiary care center from July 2015 to January 2018. We compressed the radial artery using a sphygmomanometer cuff differentially rather than a TR band proximal to the pseudoaneurysm to treat three of them. One of the patients underwent surgical repair of the pseudoaneurysm as the location of the aneurysm was not suitable for compression or thrombin injection. In our series of cases, we conclude that RAp, a rare complication of radial catheterization, was seen more commonly in elderly female patients and can be easily treated by the USG-guided differential compression, a simple and readily available method. Prevention and early diagnosis is the key to avoid serious consequences.