Author + information
- Received October 5, 2011
- Accepted October 19, 2011
- Published online June 5, 2012.
- Peter P. Rainer, MD⁎,†,
- Albrecht Schmidt, MD⁎,
- Michael Anelli-Monti, MD‡,
- Reinhold Kleinert, MD§,
- Burkert M. Pieske, MD⁎ and
- Robert M. Maier, MD⁎
A 51-year-old man with aortic valve prosthesis and dual-chamber pacemaker was admitted for evaluation of recurrent fever and chills. The level of C-reactive protein was elevated, and blood cultures were positive for Staphylococcus epidermidis. Echocardiography did not demonstrate oscillating masses; the ventricular lead, however, had a thickened “sleeve-like” appearance. The ventricular lead formed a loop that swung between the atrium and ventricle, provoking severe tricuspid regurgitation (A, B, and C [note right ventricular dilation and *moderator band], Online Videos 1, 2, and 3).
Extraction of the pacemaker device confirmed methicillin-resistant S. epidermidis–positive pacemaker lead endocarditis (D and E [intraoperative images of the lead, which is covered with a thick, irregular film (arrowheads); the valve is sclerosed (arrows)]). Persistent severe regurgitation after lead extraction necessitated valve replacement.
Prior chest radiographs demonstrated that the loop had been present for at least 10 years.
We conjectured that the mechanical stress, both to the valve and the lead, damaged the valve irreversibly and facilitated the bacterial colonization of the lead.
Dr. Rainer is funded by a Max Kade fellowship from the Austrian Academy of Sciences.
- Received October 5, 2011.
- Accepted October 19, 2011.
- American College of Cardiology Foundation