Related Experiment Videos
Right ventricular endocarditis due to infection of pacemaker apparatus
A Mehta1, M A Fisher, A C Jain
1Section of Cardiology, West Virginia University School of Medicine, Morgantown, USA.
Abstract:
This article describes an unusual case of endocarditis in a 73-year-old man with a permanent pacemaker. Echocardiography revealed vegetations in the right ventricle below the tricuspid valve only, and he required open heart surgery for removal of the pacemaker system. This case demonstrates the potentially protracted course of infective endocarditis many years after pacemaker insertion. It also emphasizes the importance of echocardiography in diagnosing right ventricular vegetations; and the need for total replacement of the endocardial pacing system whenever it becomes infected.
Insights
Infective endocarditis can occur many years after pacemaker insertion, affecting the right ventricle. Prompt diagnosis via echocardiography and complete pacemaker system replacement are crucial for managing this rare complication.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Infections
Background:
- Permanent pacemakers are widely used for cardiac rhythm management.
- Infective endocarditis is a serious infection of the heart lining or valves.
- Late-onset endocarditis following pacemaker implantation is uncommon but recognized.
Observation:
- A 73-year-old male with a permanent pacemaker presented with an unusual case of endocarditis.
- Echocardiography identified vegetations exclusively in the right ventricle, below the tricuspid valve.
- The patient underwent open-heart surgery for removal of the infected pacemaker system.
Findings:
- This case highlights the potential for a long-term, delayed presentation of infective endocarditis years after pacemaker placement.
- Echocardiography proved essential in accurately diagnosing right ventricular vegetations in this patient.
- The findings underscore the necessity of complete endocardial pacing system replacement when infection is present.
Implications:
- Physicians should maintain a high index of suspicion for late-onset endocarditis in pacemaker patients.
- Echocardiography is a critical diagnostic tool for evaluating suspected right-sided heart infections related to pacemakers.
- Infected pacemaker systems require thorough removal and replacement to ensure patient recovery and prevent recurrence.