Pulmonary embolism in infective endocarditis associated with pacemaker: report of a case and review of the literature
Keywords:
infective endocarditis, pacemaker, catheter, percutaneous extraction, pulmonary embolismAbstract
Introduction:
One of the most feared infective endocarditis (IE) complications associated with pacemaker is pulmonary embolism. We present the case of a patient with a current diagnosis of pacemaker-associated IE who presented symptoms of pulmonary embolism confirmed by imaging studies after percutaneous removal of the device.
Objectives:
to know the management and evolution, in-hospital and at 18 months of pulmonary embolism in the context of infective endocarditis associated with pacemaker.
Materials and methods:
Bibliographic search carried out in PubMed. Clinical case report: clinical evaluation, presentation of complementary studies, and treatment. Follow up on the case.
Results:
68-year-old patient with a history of dual chamber permanent pacemaker implantation 2 years ago. Prolonged febrile syndrome with no apparent focus, with positive blood cultures for methicillin-resistant Staphylococcus aureus. The transesophageal echocardiogram showed multiple vegetations associated in right atrial with the catheters. Based on the history, physical examination, and findings in specific tests, the diagnosis of IE associated with DEIP could be achieved. Antibiotic treatment and complete percutaneous removal of the device were indicated. After the procedure, he presented sudden dyspnea, confirming the diagnosis of pulmonary embolism in a ventilation-perfusion scintigram study. She completed the antibiotic treatment (vancomycin for 6 weeks) and was discharged. During follow-up, there were no new infections or other complications.
Conclusion:
in our patient pulmonary embolism did not generate changes in in-hospital morbidity and mortality or in the 18-month follow-up.
Downloads
Metrics
References
Yuan S. Right‐sided infective endocarditis: recent epidemiologic changes. Int J Clin Exp Med. 2014;7:199-218.
Grammes J, Schulze C, Al-Bataineh M, Yesenosky G, Saari C, Vrabel M, et al. Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram. J Am Coll Cardiol. 2010;55:886-894.
Bontempi L, Arabia G, Salghetti F, Cerini M, Dell'Aquila A, Milidoni A, et al. Lead-related infective endocarditis with vegetations: Prevalence and impact of pulmonary embolism in patients undergoing transvenous lead extraction. J Cardiovasc Electrophysiol. 2022;33(10):2195-2201.
Galzerano D, Pergola V, Kinsara A, Vriz O, Elmahi I, Sergani A, et al. Right-sided infective endocarditis and pulmonary embolism: a multicenter study. Monaldi Arch Chest Dis. 2022 022; 92:2251.
Noheria A, Ponamgi S, Desimone C, Vaidya V, Aakre C, Ebrille E, et al. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace. 2016;18(2):246‐252.
Victor F, De Place C, Camus C, Le Breton H, Leclercq C, Pavin D, et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart 1999;81:82-87.
Sanfilippo A, Picard M, Newell J, Rosas E, Davidoff R, Thomas J, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol . 1991; 18:1191-1199
Chan K, Tam J, Dumesnil J, Cujec B, Sanfilippo A, Jue J, et al. Effect of Long-Term Aspirin Use on Embolic Events in Infective Endocarditis. Clinical Infectious Diseases, 2008;46(1):37-41.
Habib A, Irfan M, Baddour L, Le K, Anavekar N, Lohse C, et al. Mayo Cardiovascular Infections Study Group. Impact of prior aspirin therapy on clinical manifestations of cardiovascular implantable electronic device infections. Europace . 2013;15(2):227-235.
Leeten K, Jacques N, Lancellotti P, Oury C. Aspirin or Ticagrelor in Staphylococcus aureus Infective Endocarditis: Where Do We Stand? Front Cell Dev Biol. 2021; 9.
Prendergast B, Tornos P. Surgery for Infective Endocarditis: Who and When? Circulation. 2010; 121:1141-1152.
Dickerman S, Abrutyn E, Barsic B, Bouza E, Cecchi E, Moreno A, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: An analysis from the ICE Prospective Cohort Study (ICE-PCS). Am Heart J. 2007; 154:1086-1094.
Kusumoto F, Schoenfeld M, Wilkoff B, Berul C, Birgersdotter-Green U, Carrillo R, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017 Dec;14(12):e503-e551.
