Cardiac strangulation with permanent epicardial pacemaker lead

: A 3-year-old boy underwent corrective surgery for tetralogy of Fallot. During the operation, permanent epicardial pacemaker leads were implanted for complete A-V block, which was transient and a generator implantation was not necessary. The postoperative course was uneventful and he had been doing well until nine years of age, when he was admitted to our hospital with general fatigue. The data of echo cardiogram and cardiac catheterization showed the biventricular heart failure with right ventricular outflow tract obstruction (RVOTO). Because of his rapid deterioration refractory to the intensive medical therapy, semi-emergency surgery was recommended to relieve his RVOTO. It was found during the operation that the looped pacemaker leads had carved deeply in the atrioventricular groove, so that compressed the main pulmonary artery, left main coronary artery and encircled left ventricle. The pacemaker leads were dissected as long as possible, and cut segmentally. Additionally a patch enlargement of the main pulmonary artery was necessary to relieve the residual stenosis. Although IABP support was needed in a while, his postoperative course was uneventful, and postoperative examinations showed normal cardiac function. This rare complication, so called "cardiac strangulation", should be in mind when the implantation of permanent pacemaker leads is indicated in pediatric cases.