open access

Vol 13, No 4 (2018)
Electrotherapy
Published online: 2018-09-12
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Lead-dependent infective endocarditis with a large vegetation — is cardiosurgical treatment always necessary?

Krzysztof Boczar, Andrzej Ząbek, Maciej Dębski, Robert Musiał, Jacek Lelakowski, Barbara Małecka
DOI: 10.5603/FC.2018.0079
·
Folia Cardiologica 2018;13(4):367-370.

open access

Vol 13, No 4 (2018)
Electrotherapy
Published online: 2018-09-12

Abstract

A 31-year-old patient who had cardiac pacemaker (DDD) implanted at the age of 16 due to complete atrioventricular block was admitted because of suspicion of lead-dependent infective endocarditis (LDIE). Echocardiographic examination revealed a vegetation measuring 31 x 20 mm in connection with excessive loop of atrial lead and endocardium adjacent to tricuspid valve. The patient was qualified for hybrid procedure: surgical removal of the vegetation and transvenous extraction of intracardiac leads. Considering the stable condition of the patient, it was decided to postpone the procedure and intensive treatment with antibiotics and anticoagulation therapy with low molecular weight heparin was continued. Pharmacological treatment resulted in a reduction of vegetation dimensions to 25 x 15 mm, which allowed for changing the qualification of the procedure to transvenous lead extraction (TLE) of the DDD system. The procedure was carried out without complications. After normalization of inflammatory parameters and disappearance of the vegetation, a new stimulation system was implanted on the same side of the chest. During one-year follow-up, there was no recurrence of the infection.

Abstract

A 31-year-old patient who had cardiac pacemaker (DDD) implanted at the age of 16 due to complete atrioventricular block was admitted because of suspicion of lead-dependent infective endocarditis (LDIE). Echocardiographic examination revealed a vegetation measuring 31 x 20 mm in connection with excessive loop of atrial lead and endocardium adjacent to tricuspid valve. The patient was qualified for hybrid procedure: surgical removal of the vegetation and transvenous extraction of intracardiac leads. Considering the stable condition of the patient, it was decided to postpone the procedure and intensive treatment with antibiotics and anticoagulation therapy with low molecular weight heparin was continued. Pharmacological treatment resulted in a reduction of vegetation dimensions to 25 x 15 mm, which allowed for changing the qualification of the procedure to transvenous lead extraction (TLE) of the DDD system. The procedure was carried out without complications. After normalization of inflammatory parameters and disappearance of the vegetation, a new stimulation system was implanted on the same side of the chest. During one-year follow-up, there was no recurrence of the infection.

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Keywords

vegetation, infective endocarditis, pacemaker, complication

About this article
Title

Lead-dependent infective endocarditis with a large vegetation — is cardiosurgical treatment always necessary?

Journal

Folia Cardiologica

Issue

Vol 13, No 4 (2018)

Pages

367-370

Published online

2018-09-12

DOI

10.5603/FC.2018.0079

Bibliographic record

Folia Cardiologica 2018;13(4):367-370.

Keywords

vegetation
infective endocarditis
pacemaker
complication

Authors

Krzysztof Boczar
Andrzej Ząbek
Maciej Dębski
Robert Musiał
Jacek Lelakowski
Barbara Małecka

References (8)
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  7. Małecka B, Kutarski A, Tomaszewski A, et al. Transvenous removal of endocardial leads with coexisting great vegetation (3.5 cm)--case report. Europace. 2010; 12(3): 445–446.
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