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Transvenous pacemaker lead removal in pacemaker lead endocarditis with large vegetations: a report of two cases.

Cho H, Kim M, Uhm JS, Pak HN, Lee MH, Joung B - Korean Circ J (2014)

Bottom Line: In this case report, we present two patients with pacemaker lead endocarditis with large vegetations of maximum diameter 2.4 cm and 3.2 cm.The first patient had multiple vegetations attached to the tricuspid and mitral valves and developed septic emboli to the brain, lung, and liver.Both patients were successfully treated with transvenous pacemaker lead removal and antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. The outcomes of patients undergoing percutaneous lead extraction for large vegetations (>2 cm) have not yet been shown. In this case report, we present two patients with pacemaker lead endocarditis with large vegetations of maximum diameter 2.4 cm and 3.2 cm. The first patient had multiple vegetations attached to the tricuspid and mitral valves and developed septic emboli to the brain, lung, and liver. The second patient had a large, persistent vegetation on the tricuspid valve, even two weeks after complete removal of the leads. Both patients were successfully treated with transvenous pacemaker lead removal and antibiotics.

No MeSH data available.


Related in: MedlinePlus

A: brain MRI showing multiple acute infarcts in the bilateral cerebral hemispheres, suggestive of embolism. B: a CT scan of the chest showing small and solid cavitary nodules, suggesting septic embolism. C: a CT scan of the abdomen showing small, ill-defined, low-attenuated lesions in segment 6 of the liver, which can be inflammatory lesions but is difficult to characterize with single-phase CT. CT: computed tomography, MRI: magnetic resonance imaging.
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Figure 2: A: brain MRI showing multiple acute infarcts in the bilateral cerebral hemispheres, suggestive of embolism. B: a CT scan of the chest showing small and solid cavitary nodules, suggesting septic embolism. C: a CT scan of the abdomen showing small, ill-defined, low-attenuated lesions in segment 6 of the liver, which can be inflammatory lesions but is difficult to characterize with single-phase CT. CT: computed tomography, MRI: magnetic resonance imaging.

Mentions: Upon admission, the patient was febrile with a temperature of 38.3℃, confused and had dysarthric speech. Physical examination was remarkable for warmth, erythema, and tenderness of the skin overlying the pacemaker pocket, which was exposed. His white blood cell (WBC) count was 18.40×103/µL, and C-reactive protein (CRP) concentration was 148.27 mg/L. Transthoracic echocardiogram (TTE) revealed vegetations attached to the tricuspid valve (2.4×1.1 cm) (Fig. 1A, arrow), right atrium (0.8×0.8 cm) (Fig. 1A, broken arrow), and mitral valve (0.7×0.5 cm) (Fig. 1B, arrow). Brain magnetic resonance imaging results were consistent with multiple acute embolic infarcts (Fig. 2A). Computed tomography scan of the chest and abdomen showed multiple cavitary nodules in both lungs (Fig. 2B) and small, low-attenuated lesions in segment 6 of the liver (Fig. 2C), suggesting septic embolism.


Transvenous pacemaker lead removal in pacemaker lead endocarditis with large vegetations: a report of two cases.

Cho H, Kim M, Uhm JS, Pak HN, Lee MH, Joung B - Korean Circ J (2014)

A: brain MRI showing multiple acute infarcts in the bilateral cerebral hemispheres, suggestive of embolism. B: a CT scan of the chest showing small and solid cavitary nodules, suggesting septic embolism. C: a CT scan of the abdomen showing small, ill-defined, low-attenuated lesions in segment 6 of the liver, which can be inflammatory lesions but is difficult to characterize with single-phase CT. CT: computed tomography, MRI: magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3958606&req=5

Figure 2: A: brain MRI showing multiple acute infarcts in the bilateral cerebral hemispheres, suggestive of embolism. B: a CT scan of the chest showing small and solid cavitary nodules, suggesting septic embolism. C: a CT scan of the abdomen showing small, ill-defined, low-attenuated lesions in segment 6 of the liver, which can be inflammatory lesions but is difficult to characterize with single-phase CT. CT: computed tomography, MRI: magnetic resonance imaging.
Mentions: Upon admission, the patient was febrile with a temperature of 38.3℃, confused and had dysarthric speech. Physical examination was remarkable for warmth, erythema, and tenderness of the skin overlying the pacemaker pocket, which was exposed. His white blood cell (WBC) count was 18.40×103/µL, and C-reactive protein (CRP) concentration was 148.27 mg/L. Transthoracic echocardiogram (TTE) revealed vegetations attached to the tricuspid valve (2.4×1.1 cm) (Fig. 1A, arrow), right atrium (0.8×0.8 cm) (Fig. 1A, broken arrow), and mitral valve (0.7×0.5 cm) (Fig. 1B, arrow). Brain magnetic resonance imaging results were consistent with multiple acute embolic infarcts (Fig. 2A). Computed tomography scan of the chest and abdomen showed multiple cavitary nodules in both lungs (Fig. 2B) and small, low-attenuated lesions in segment 6 of the liver (Fig. 2C), suggesting septic embolism.

Bottom Line: In this case report, we present two patients with pacemaker lead endocarditis with large vegetations of maximum diameter 2.4 cm and 3.2 cm.The first patient had multiple vegetations attached to the tricuspid and mitral valves and developed septic emboli to the brain, lung, and liver.Both patients were successfully treated with transvenous pacemaker lead removal and antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. The outcomes of patients undergoing percutaneous lead extraction for large vegetations (>2 cm) have not yet been shown. In this case report, we present two patients with pacemaker lead endocarditis with large vegetations of maximum diameter 2.4 cm and 3.2 cm. The first patient had multiple vegetations attached to the tricuspid and mitral valves and developed septic emboli to the brain, lung, and liver. The second patient had a large, persistent vegetation on the tricuspid valve, even two weeks after complete removal of the leads. Both patients were successfully treated with transvenous pacemaker lead removal and antibiotics.

No MeSH data available.


Related in: MedlinePlus