Một bệnh nhân trẻ tuổi bị bệnh tim bẩm sinh, ngay cả với những vết sẹo phẫu thuật trước đó, xứng đáng với kết quả tốt nhất có thể mỹ phẩm từ một máy điều hòa nhịp tim | CHAPTER 2 Transvenous pacemaker implantation A young patient with congenital heart disease even with previous surgical scars deserves the finest possible cosmetic result from a pacemaker or ICD implantation. The subclavicular incision remains the best long-term option if new leads are required in the future using the same incision. However an alternative approach at the antero-axillary fold will allow access to the subclavian vein whilst at the same time hiding the incision in the axilla 1 . This appooach commonly limited to females requires a venogram to demonstrate the vein and a second incision under the breast for pulse generator placement. However it is important to remember that a previous open thoracotomy associated with congenital heart surgery as a child may result in chest wall deformities and vascular distortion later in life which can complicate standard vascular access for lead insertion. The subclavicular approach allows rapid access by the cutdown technique to the cephalic vein avoiding the use of a subclavian puncture with all its recognized compiicaióons 2 3 . Implanti fa fanfiliar with toe technique of cephalic vein isolation and cannulation can rapidly implant one or more leads even in a small vein. In order to achieve this many implanting physiciansnow use introducersin order to passthe leadsinto the proximal veins 4 . These introducers are best inserted using a very floppy flexible tip guide wire which is passed along the vein to the heart mm flexible tip Radifocus Glidewire - Terumo Corporation Tokyo Japan Figure . Short 80cm wires are avaiSable oor this p i j osc se- Tlw wire has a nitinol core which is composed of a super-elastic nickel titanium alloy. It isthen covered with radio-opaque polyurethane and coated with a hydrophilic polymer. Once the cephalic vein is isolated and cleaned the distal end is ligated and the proximal end secured using absorbable suture. A small transverse incision is made with fine or iris scissors .
