Introduction: A case of right sub-pectoral pacemaker implantation in an adolescent subsequent to a right atrial myxoma operation, using the same scar and repairing the mini thoracotomic access.
Methods: A 16 yo adolescent had a diagnosis of right atrial mass, was operatively approached using a right mini-thoracotomy. The post-operative follow-up was complicated for a persistent 3rd degree AV block. A dual chamber pacemaker implantation was planned. A thoracic asymmetry was present because of a lack of intercostal muscle suture and pectoral muscle retraction maintaining the intercostal incompetence and guaranteeing an acceptable respiratory function. Was planned a right submuscolar approach using the same thoracotomy scar. The leads were placed using the right cephalic vein within the delto-pectoral groove. Then the previous scar was opened, the pectoralis was dissected and a massive pneumothorax was elicited. The complication was obviated with a Parietex™ net anchored on the costal margins, the thoracic drain positioning the pacemaker was placed under the pectoral muscle after the tunnelization of the leads from delto-pectoral groove.
Conclusions: In our case the pacemaker implant was unavoidable because of the AV block. The unusual approach was justified by functional and aesthetically reasons, taking advantage of the previous scar and correcting with the device itself a structural defect created from the previous intervention.