Pacemaker Lead Vegetation Trapped in Patent Foramen Ovale
2009; Lippincott Williams & Wilkins; Volume: 119; Issue: 8 Linguagem: Inglês
10.1161/circulationaha.108.820654
ISSN1524-4539
AutoresYvan Le Dolley, Franck Thuny, Emilie Bastard, Alberto Ribéri, Laurence Tafanelli, Sébastien Renard, Frédéric Franceschi, Sébastien Prévôt, Jean‐François Avierinos, Gilbert Habib, Jean‐Claude Deharo,
Tópico(s)Takotsubo Cardiomyopathy and Associated Phenomena
ResumoHomeCirculationVol. 119, No. 8Pacemaker Lead Vegetation Trapped in Patent Foramen Ovale Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBPacemaker Lead Vegetation Trapped in Patent Foramen OvaleA Cause of Hypoxemia After Percutaneous Extraction Yvan Le Dolley, Franck Thuny, Emilie Bastard, Alberto Riberi, Laurence Tafanelli, Sébastien Renard, Frédéric Franceschi, Sébastien Prévot, Jean-François Avierinos, Gilbert Habib and Jean-Claude Deharo Yvan Le DolleyYvan Le Dolley From the Department of Cardiology, La Timone Hospital, Marseille, France. , Franck ThunyFranck Thuny From the Department of Cardiology, La Timone Hospital, Marseille, France. , Emilie BastardEmilie Bastard From the Department of Cardiology, La Timone Hospital, Marseille, France. , Alberto RiberiAlberto Riberi From the Department of Cardiology, La Timone Hospital, Marseille, France. , Laurence TafanelliLaurence Tafanelli From the Department of Cardiology, La Timone Hospital, Marseille, France. , Sébastien RenardSébastien Renard From the Department of Cardiology, La Timone Hospital, Marseille, France. , Frédéric FranceschiFrédéric Franceschi From the Department of Cardiology, La Timone Hospital, Marseille, France. , Sébastien PrévotSébastien Prévot From the Department of Cardiology, La Timone Hospital, Marseille, France. , Jean-François AvierinosJean-François Avierinos From the Department of Cardiology, La Timone Hospital, Marseille, France. , Gilbert HabibGilbert Habib From the Department of Cardiology, La Timone Hospital, Marseille, France. and Jean-Claude DeharoJean-Claude Deharo From the Department of Cardiology, La Timone Hospital, Marseille, France. Originally published3 Mar 2009https://doi.org/10.1161/CIRCULATIONAHA.108.820654Circulation. 2009;119:e223–e224A 71-year-old man was admitted to our department with suspected pacemaker endocarditis because of unexplained fever and Staphylococcus epidermidis bacteremia. The patient's history revealed a double-chamber pacemaker implantation 7 years ago for third-degree atrioventricular block. Transesophageal echocardiography showed a significant thickening of both leads associated with a mobile 2.7-cm vegetation on the ventricular lead. A patent foramen ovale was also noted on transesophageal echocardiography (Figure 1; supplemental Movie I). The diagnosis of endocarditis was thus confirmed, and percutaneous lead extraction was planned under antibiotic therapy with prior epicardial implantation. The extraction procedure was performed by lead traction associated with a laser sheath for both the auricular and ventricular leads. The immediate systematic transthoracic echocardiography control showed an 8-cm-long new echogenic, mobile, tubular mass through the tricuspid valve (Figure 2; Movie II). Forty-eight hours later, the patient presented with a sudden and transient episode of hypoxemia, with a shunt effect without acute heart failure. The thoracic CT scan did not reveal any pulmonary embolism, but a mass was seen in the left atrium and extending through the patent foramen ovale, in association with a pericardial effusion (Figure 3). Transesophageal echocardiography showed that the tubular mass was inserted in the superior vena cava and extended into the right atrium, as well as into the left atrium, through a patent foramen ovale, reaching the mitral valve without hampering its movement (Figure 4; Movies III and IV). We hypothesized that the floating mass in the right atrium, which had prolapsed through the patent foramen ovale, could be a residual infected vegetation that surrounded the pacemaker lead. Because of the high potential embolic risk, surgical extraction was performed (Figure 5). Download figureDownload PowerPointFigure 1. Transesophageal echocardiography 4-chamber view showing a large vegetation on 1 of the pacemaker leads (white arrow). On this examination, an aneurysm of the interatrial septum with a patent foramen ovale was also present. LA indicates left atrium; RA, right atrium; and LVOT, left ventricular outflow tract.Download figureDownload PowerPointFigure 2. Transthoracic echocardiography apical 5-chamber view showing an echogenic, mobile, and tubular mass through the tricuspid valve (white arrow). RV indicates right ventricle; LV, left ventricle; RA, right atrium; and LA, left atrium.Download figureDownload PowerPointFigure 3. CT scan of cardiac cavities revealing a mass in the left atrium (black arrow) and a pericardial effusion (white arrow).Download figureDownload PowerPointFigure 4. Transesophageal echocardiography view showing a mass inserted into the superior vena cava, reaching the left atrium through the patent foramen ovale (A). The mobile mass reaches the mitral valve without hampering its movement (B). LA indicates left atrium; RA, right atrium; SVC, superior vena cava; and RV, right ventricle.Download figureDownload PowerPointFigure 5. Intraoperative photograph. View from a right atriotomy showing the mass (white arrow) crossing through the patent foramen ovale and reaching the left atrium (A). The 10-cm-long mass corresponded to a vegetation after surgical resection (B).Device extraction combined with antibiotherapy is the recommended treatment for pacemaker endocarditis. Percutaneous extraction is performed more and more frequently, even with large vegetations. The persistence of a residual infected sheath as a "ghost" of lead infection is not a well-known complication of percutaneous lead extraction. This case is original because of its clinical presentation, which suggests the need for reconsideration of percutaneous lead extraction in the presence of a large vegetation and patent foramen ovale.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/119/8/e223/DC1.DisclosuresNone.FootnotesCorrespondence to Doctor Franck Thuny, Département de Cardiologie, Hôpital de la Timone, Bd Jean Moulin, 13005 Marseille, France. E-mail [email protected] eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Perrin T and Deharo J (2021) Therapy and outcomes of cardiac implantable electronic devices infections, EP Europace, 10.1093/europace/euab016, 23:Supplement_4, (iv20-iv27), Online publication date: 23-Jun-2021. Kiuchi K, Fukuzawa K, Mori S, Nishii T, Matsumoto K, Ichibori H and Yamada T (2017) The details of an unusual "ghost" after transvenous lead extraction: Three-dimensional computed tomography analysis, Journal of Arrhythmia, 10.1016/j.joa.2017.07.008, 33:6, (640-642), Online publication date: 1-Dec-2017. Narducci M, Di Monaco A, Pelargonio G, Leoncini E, Boccia S, Mollo R, Perna F, Bencardino G, Pennestrì F, Scoppettuolo G, Rebuzzi A, Santangeli P, Di Biase L, Natale A and Crea F (2016) Ghostbusters should come back to lead extraction arena in order to fight with ghosts: authors reply, Europace, 10.1093/europace/euw308, (euw308) Narducci M, Di Monaco A, Pelargonio G, Leoncini E, Boccia S, Mollo R, Perna F, Bencardino G, Pennestrì F, Scoppettuolo G, Rebuzzi A, Santangeli P, Di Biase L, Natale A and Crea F (2016) Presence of 'ghosts' and mortality after transvenous lead extraction, Europace, 10.1093/europace/euw045, (euw045) Siddiqui W, Acharya I, Iyer P, Khan M, Rafique M, Kaji A and Gala K (2016) Vegetation Attached to the Left Interatrial Septal Surface at the Congenital Location of the Foramen Ovale: A Rare Occurrence, American Journal of Case Reports, 10.12659/AJCR.900848, 17, (837-840) Le Dolley Y, Thuny F, Mancini J, Casalta J, Riberi A, Gouriet F, Bastard E, Ansaldi S, Franceschi F, Renard S, Prevot S, Giorgi R, Tafanelli L, Avierinos J, Raoult D, Deharo J and Habib G (2010) Diagnosis of Cardiac Device–Related Infective Endocarditis After Device Removal, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2009.12.016, 3:7, (673-681), Online publication date: 1-Jul-2010. March 3, 2009Vol 119, Issue 8 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.820654PMID: 19255349 Originally publishedMarch 3, 2009 PDF download Advertisement SubjectsComputerized Tomography (CT)Electrocardiology (ECG)Infectious EndocarditisPacemaker
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