[Chylothorax as a late complication of pacemaker endocarditis]

The mortality observed in pacemaker endocarditis may be high when all the components of the device are not withdrawn. Few studies have reported the posterior morbidity once the acute disease is resolved. Herein we present a patient who developed superior vena cava thrombosis, obstruction of thoracic duct and chylothorax after the initial episode of endocarditis. The evolution of the patient illustrates the late complications of isolated antibiotic treatment of pacemaker endocarditis, the poor results obtained with temporal oral anticoagulation in the management of superior vena cava thrombosis in the presence of retained intravascular foreign material, the excellent, prolonged initial response of chylothorax to conservative measures with anticoagulation and diet, relapse of chylothorax related to the increase in arterial pulmonary pressure, the absence of response at this time to the dietary measures and the successful treatment with video-assisted thoracic surgery to treat chylothorax without the morbidity of the large surgical procedures.