DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Status post syncopal episode.
2. Severe bradycardia with severe hypertension.
3. Sick sinus syndrome.
4. Hyperlipidemia.
POSTOPERATIVE DIAGNOSES:
1. Status post syncopal episode.
2. Severe bradycardia with severe hypertension.
3. Sick sinus syndrome.
4. Hyperlipidemia.
OPERATION PERFORMED:
Urgent insertion of permanent pacemaker, DDD, under fluoroscopy.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: Local.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in the supine position. Support lines were placed. The neck and anterior chest were prepped and draped in the usual sterile fashion. Local anesthesia was given using 1% lidocaine.
After this was performed, distal left subclavian vein was accessed with an 18 gauge needle. Following this, a guidewire was advanced through the 18 gauge needle and was advanced towards the right atrium under fluoroscopic guidance. Once in this position, the 18 gauge needle was removed.
Next, an incision was performed approximately 1 cm below the insertion site of the guidewire. This incision was taken down through skin and subcutaneous tissue down through aponeurosis of the pectoralis major muscle. After this was performed, hemostasis was achieved using Bovie cautery and a subcutaneous pocket was created.
The guidewire was then excised through this wound, and using the Seldinger technique, a dilator and introducer were placed under fluoroscopic guidance. Once in place, the guidewire and dilator were removed. Using this introducer, right ventricular lead was advanced towards the apex of the right ventricle, and we positioned the lead where we obtained the best electrophysiological data.
Once in the correct position, the right ventricle lead was secured to the pectoralis major muscle with 2-0 silk suture. Following this, a second stick was performed to the left subclavian vein. A guidewire was advanced under fluoroscopic guidance. Once in place, a dilator and introducer were placed in the subclavian vein under fluoroscopic guidance. Once this was in a correct position, the guidewire and dilator were removed and the right atrial lead was advanced through this introducer. The right atrial lead was then positioned under fluoroscopic guidance where we obtained the best electrophysiological data.
Once this was performed, the introducer was removed, and the right atrial lead was secured to the pectoralis major fascia with 2-0 silk suture. Following this, the right atrial and right ventricular leads were connected to a pulse generator. This was then checked and was working perfectly. The pulse generator was then placed in the previously created subcutaneous pocket. The wound was then irrigated with antibiotic solution, and the wound was closed in layers. The patient tolerated the procedure and was transferred to the recovery room in stable condition.
