[Patch angioplasty for superior vena cava syndrome after pacemaker implantation and maze procedure for chronic atrial fibrillation; report of a case].

In 1984, the patient, a 68-year-old male, underwent pacemaker implantation for the treatment of sick sinus syndrome. Because of a postoperative pocket infection, the atrial lead was removed ; but it was difficult to extract the ventricular lead, which was therefore left in place. While under observation, transient facial edema, atrial fibrillation, chest discomfort were noted. Chest X-ray revealed that the ventricular lead had gradually moved to the side of the pulmonary artery. Pre-operative phlebography of the internal jugular vein led to a diagnosis of obstruction of the superior vena cava (SVC). Maze procedure was performed and the lead was readily removed through the right atriotomy. The obstruction was incised and the lesion reconstructed by using a patch by the autologous pericardium. The satisfactory return of circulation was confirmed by postoperative imaging. At the discharge, an electrocardiograph indicated a sinus rhythm and a heart rate was 82 ppm. The facial edema and thoracic symptoms had been completely eliminated.