Askari Behnam, Dehghani Mohammadreza, Babakan Roghie.
Implantable cardioverter-defibrillator (ICD) leads extraction in infective endocarditis using open heart surgery: a case report.
Pak Heart J Jan ;50(2):131-4.

Implantable cardioverter-defibrillator (ICD) endocarditis is a rare but potentially lethal complication .Chronically implanted transvenous leads adhere to thevenous endothelium and endocardial tissues over time due to fbrosis. Removal of such leads can be a signifcantly complex procedure .There are several approaches to remove transvenously introduced ICD leads. Failure to retrieve transvenous leads, as well as large endocarditic vegetations, is commonly accepted indications for open heart surgery using cardiopulmonary bypass. We present a case of an infective endocarditis in a 44-year-old man. He had a history of implantable cardioverter defibrillators (ICD) implantation. He was admitted with high grade fever, dyspnea and cough with sputum. In evaluation there was a 24x32mm sized vegetative mass on the leads situated in the right atrium. Antibiotic therapy with vancomycin and meropenem was started .The patient was considered a candidate for surgical removal of ICD Leads because of chronically implanted transvenous leads and large size of vegetation. With cardiopulmonary bypass (CPB) but without cardiac arrest, vegetations and leads were removed. This method prevents the risk of pulmonary embolisation associated with vegetation and mechanic injury to the tricuspid valve and right ventricle.

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