Saved by a Silent Hero: How a Low Pacemaker Battery Rescued a Life

P0294 

Case Video Submission 

Margaret Connolly (1), Jordan Bloom (1)

(1) Massachusetts General Hospital, Boston, MA

Margaret Connolly    -  Contact Me
Massachusetts General Hospital

Jordan Bloom    -  Contact Me
Massachusetts General Hospital

Margaret Connolly    -  Contact Me
N/A

Objective: To review a unique case presentation that began with a low pacemaker battery.

Case Video Summary: This is a case of a patient whose pacemaker battery became low, triggering symptoms that ultimately saved her life. The patient is a 78-year-old woman who previously underwent aortic valve replacement with coronary artery bypass grafting in 2005. This was complicated by heart block requiring a pacemaker. Over the subsequent years she suffered from structural valve degeneration and underwent a valve-in-valve femoral transcatheter aortic valve replacement (TAVR) in 2018. In 2023, the patient presented with dyspnea and malaise. Workup revealed that her pacemaker device had reached the elective replacement indicator (ERI). Device interrogation demonstrated that the onset of her symptoms matched the timing of ERI. Further imaging revealed that the patient had a large ascending aortic aneurysm, measuring 6.4 centimeters, which was increased from 5 centimeters the year prior.

The operative video demonstrates the finding of a complex chronic aortic dissection flap in her proximal ascending aorta, which was not recognized on preoperative imaging. A second chronic flap, presumably the re-entry tear was identified during hemiarch replacement. The timing of her dissection is unknown but occurred at some point after her transfemoral TAVR. She ultimately underwent uncomplicated revision sternotomy, explantation of surgical and valve-in-valve TAVR valves with tissue aortic valve replacement, and replacement of the ascending and hemi-aortic arch.

Conclusions: The constellation of symptoms prompting initial presentation may yield surprising findings when investigated thoroughly.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)