Images in Cardiovascular Medicine Dense Right-Sided Hemiparesis in a 36-Year-Old Woman Anne B. Curtis, MD; Edward Gesier, MD; Raymond G. Cutro, MD S ix months after implantation of a dual-chamber pacemaker at an outside facility for sinus bradycardia, a 38-year-old woman had a cerebrovascular accident that resulted in aphasia and dense right-sided hemiparesis. A transthoracic echocardiogram demonstrated a patent foramen ovale, and she was referred for further evaluation. On review of the echocardiogram, it was determined that the atrial lead traversed the patent foramen and the tip was in the mid-left atrium. After ⬎6 weeks of adequate anticoagulation, the lead was removed, and a new atrial lead was placed in the right atrial appendage. The posteroanterior (PA) and lateral chest x-rays on the left (Figure 1) show the original position of the atrial lead in the left atrium. The PA and lateral chest x-rays on the right (Figure 2) show the new atrial lead in the right atrium. What is notable is that the PA views do not look very different, which would make it difficult to recognize that the original lead was positioned in the left atrium. However, the lateral film clearly shows the atrial lead coursing posteriorly and thus in the left atrium, compared with the lateral film after replacement of the lead, which shows the correct anterior position of the right atrial lead. Lateral chest x-ray films are important after placement of permanent pacing leads to assure proper lead position. Figure 1. PA and lateral chest x-rays on the left. Figure 2. PA and lateral chest x-rays on the right. From University of Florida Division of Cardiovascular Medicine, Gainesville, Fla. Correspondence to Raymond Cutro, MD, University of Florida Division of Cardiovascular Medicine, 1600 SE Archer Rd, POB 100277, Gainesville, FL 32610. E-mail jolicmd@medicine.ufl.edu (Circulation. 2005;112:e67.) © 2005 American Heart Association, Inc. Circulation is available at http://www.circulationaha.org DOI: 10.1161/CIRCULATIONAHA.104.480988 e67at University of Calgary on May 25, 2015 Downloaded from http://circ.ahajournals.org/ Dense Right-Sided Hemiparesis in a 36-Year-Old Woman Anne B. Curtis, Edward Gesier and Raymond G. Cutro Circulation. 2005;112:e67 doi: 10.1161/CIRCULATIONAHA.104.480988 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2005 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/112/5/e67 Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/ Downloaded from http://circ.ahajournals.org/ at University of Calgary on May 25, 2015