Figure 1 - uploaded by Jun Gu
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TEE image of this patient with pacemaker induced endocarditis of tricuspid valve. Upper panel: Mid-esophageal four chamber and aortic valve short axis views showed a mass attaching to the tricuspid valve. Lower panel: RT3D TEE confirmed highly mobile vegetation attached to posterior and septal leaflet of the tricuspid valve which was originated from pacemaker lead. During systolic phase (Left panel) the vegetation was protruding into right atrium, during diastolic phase (Right panel) the vegetation was moving back to right ventricle with tricuspid valve indicating the vegetation was attach to the tricuspid valve.
Source publication
The infection of cardiac implantable electronic device is a serious and potentially lethal complication. Accurate preoperative evaluation of location of vegetation, cardiac valve pathology is of paramount important. We reported a case of 71 year-old male patient who suffered from pacemaker endocarditis was given suitable surgical treatment under th...
Contexts in source publication
Context 1
... echocardiogram (TTE) revealed the pacemaker in the right ventricular and a giant vegetation sized 16*10 mm in the tricus- pid valve causing moderate insufficiency, however, due to poor image quality, relationship between pacemaker lead and the vegetation could not be identified. Trans- esophageal echocardiogram (TEE) was then utilized for further evaluation which confirmed not only a large vege- tation attaching to the tricuspid valve causing tricuspid valve insufficiency but also no thickening, adhesion or limited opening of the tricuspid valve (Figure 1 -upper panel). Further RT3D TEE confirmed a highly mobile vegetation sized 17*11*8 mm attach to posterior as well as septal leaflet of the tricuspid valve which was originated from pacemaker lead. ...
Context 2
... RT3D TEE confirmed a highly mobile vegetation sized 17*11*8 mm attach to posterior as well as septal leaflet of the tricuspid valve which was originated from pacemaker lead. (Figure 1 -lower panel). This pa- tient was then underwent open heart surgical procedure done through the right atrium with cardio-pulmonary by- pass and cardiac arrest. ...
Citations
The growing use of cardiac implantable electronic devices (CIED) has led to infections requiring intervention. These are traditionally managed using a percutaneous transvenous approach to fully extract the culpable leads. Indications for such strategies are well-established and range from simple traction to the use of powered extraction tools including laser sheaths. Where such attempts fail, or if there are further complications, then there may be need for a cardiothoracic surgical approach. Limited evidence is currently available on the merits of individual strategies, and these are mainly drawn from case reports or series. Most utilise cardiopulmonary bypass, cardioplegic arrest and entry within the right atrium to allow direct visualisation of any vegetation and safely explant all CIED components whilst avoiding perforation, valvular and paravalvular damage. In this review, we describe a number of these and the unique challenges faced by surgeons when attempting to extract CIED. It is clear that future work should concentrate on creating clear consensus and guidelines on indications, risks and measures of efficacy outcomes for various surgical techniques.
