IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) LEADS EXTRACTION IN INFECTIVE ENDOCARDITIS USING OPEN HEART SURGERY: A CASE REPORT

Abstract

Implantable cardioverter-defibrillator (ICD) endocarditis is a rare but potentiallylethal complication .Chronically implanted transvenous leads adhere to thevenous endothelium and endocardial tissues over time due to ?brosis. Removalof such leads can be a signi?cantly complex procedure .There are severalapproaches to remove transvenously introduced ICD leads. Failure to retrievetransvenous leads, as well as large endocarditic vegetations, is commonlyaccepted indications for open heart surgery using cardiopulmonary bypass.We present a case of an infective endocarditis in a 44-year-old man. He had ahistory of implantable cardioverter de?brillators (ICD) implantation. He wasadmitted with high grade fever, dyspnea and cough with sputum. In evaluationthere was a 24x32mm sized vegetative mass on the leads situated in the rightatrium. Antibiotic therapy with vancomycin and meropenem was started .Thepatient was considered a candidate for surgical removal of ICD Leads becauseof chronically implanted transvenous leads and large size of vegetation. Withcardiopulmonary bypass (CPB) but without cardiac arrest, vegetations and leadswere removed. This method prevents the risk of pulmonary embolisationassociated with vegetation and mechanic injury to the tricuspid valve and rightventricle.