Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2023; 11(35): 8364-8371
Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8364
Balloon venoplasty for disdialysis syndrome due to pacemaker-related superior vena cava syndrome with chylothorax post-bacteraemia: A case report
Satomi Yamamoto, Michitsugu Kamezaki, Junichi Ooka, Toru Mazaki, Yoshiaki Shimoda, Takaaki Nishihara, Yoko Adachi
Satomi Yamamoto, Michitsugu Kamezaki, Takaaki Nishihara, Yoko Adachi, Department of Nephrology, Kobe Central Hospital, Kobe 651-1145, Japan
Junichi Ooka, Toru Mazaki, Yoshiaki Shimoda, Department of Cardiology, Kobe Central Hospital, Kobe 651-1145, Japan
Author contributions: Yamamoto S, Kamezaki M, Ooka J, and Adachi Y oversaw the patient from admission and diagnosed SVC syndrome based on the patient's physical findings and CECT; Ooka J, Mazaki T, and Shimoda Y developed a specific treatment plan and performed endovascular therapy; Yamamoto S wrote the manuscript; all authors reviewed and approved the final manuscript.
Informed consent statement: The patient provided informed written consent prior to catheter intervention.
Conflict-of-interest statement: No conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michitsugu Kamezaki, MD, PhD, Department of Nephrology, Kobe Central Hospital, 2-1-1, Souyama-cho, kita-ku, Kobe 651-1145, Japan. kamezaki@koto.kpu-m.ac.jp
Received: August 30, 2023
Peer-review started: August 30, 2023
First decision: October 10, 2023
Revised: October 21, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 16, 2023
Abstract
BACKGROUND

Although superior vena cava (SVC) syndrome has also been reported as a late complication of pacemaker (PM) implantation, acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantation is very rare. There are no specific therapies or guidelines.

CASE SUMMARY

A 96-year-old woman receiving dialysis was implanted with a PM due to sick sinus syndrome. She was referred to our facility for chest discomfort experienced during dialysis. Upon examination, unilateral pleural effusion on the right side was cloudy with a foul odour. The patient was diagnosed with pyothorax and treated with antibiotics. After the effusion was reduced, it gradually reaggravated and remained cloudy. In this case, SVC syndrome, which is generally considered a late complication after PM implantation, rapidly developed following the bacteraemia, resulting in impaired venous return, chylothorax, and disdialysis syndrome. After catheter intervention for SVC stenosis, the patient’s symptoms promptly improved. The patient has been recurrence-free for a year.

CONCLUSION

Acute SVC syndrome can cause dysdialysis in PM-implanted patients. Catheter intervention alone has improved this condition for a traceable period.

Keywords: Superior vena cava syndrome, Pacemaker implantation complications, Disdialysis, Case report

Core Tip: While superior vena cava (SVC) syndrome has also been reported as a late complication after pacemaker (PM) implantation, our case is novel because, to the best of our knowledge, no instances of ‘acute’ SVC syndrome resulting in disdialysis in a patient on maintenance haemodialysis after PM implantation has been reported. We wish to emphasize the following key points: (1) Acute-onset SVC syndrome should be considered when acute disdialysis is encountered in patients with a PM on dialysis; and (2) the efficacy of treatment using percutaneous old balloon angioplasty alone, which has demonstrated long-term effectiveness.