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Case Reports
. 2012 Jun 14:2012:bcr0920114855.
doi: 10.1136/bcr.09.2011.4855.

Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

Karin Anne Lydia Mueller  1 , Iris I Mueller, Hans-Joerg Weig, Volker Doernberger, Meinrad Gawaz
Affiliations
Case Reports

Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

Karin Anne Lydia Mueller et al. BMJ Case Rep. .

Abstract

CD endocarditis is a potentially lethal complication after implantation of permanent pacemakers or implantable cardioverter-defibrillators. Complete extraction of the hardware along with antibiotic treatment is the standard therapy. However, there is no standard procedure in the treatment of lead-associated infective endocarditis with large thrombotic vegetations. The authors present the case of a 60-year-old patient with a large vegetation located on the right atrial lead. Due to a high surgical and thrombembolic risk, especially of acute massive pulmonary embolism, the patient received recombinant tissue plasminogen activator to dissolve the thrombus under echocardiographic monitoring. The thrombotic masses were substantially reduced after thrombolysis. Therefore, standard transvenous extraction of the leads could be performed and high risk cardiac re-operation could be avoided.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
(A, B) Transthoracic apical four chamber view demonstrates a large vegetation (24×46 mm) in the right atrium adherent on the right atrial lead with protrusion in the right ventricle (A). Transoesophageal echocardiography shows three vegetations, two small masses 6×12 mm and 6×9 mm and one large mass (36×41 mm) adherent on the atrial lead and reaching into the vena cave superior (B). (C, D) Transoesophageal and transthoracic echocardiography shows slightly reduced thrombotic mass on the right atrial lead after the first thrombolysis with 50 mg recombinant tissue plasminogen activator over 2 h. (E, F) After the second thrombolysis thransthoracic echocardiography does not show any vegetations in the apical four chamber view (E). Transoesophageal echocardiography confirms that the large vegetion on the right atrial lead is dissolved, thrombotic masses remain in the vena cava superior measuring 10×20 mm which means a significant reduction of the thrombotic mass in the right atrium after lysis (F).
See this image and copyright information in PMC

References

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