Using a Dotter's basket in the right ventricular outflow tract may enable safe transvenous lead extraction in high-risk patients with large vegetations who are poor surgical candidates.
May support basket-assisted extraction in poor surgical candidates with large vegetations; leaves open need for prospective safety data before wider use.
We discuss a case of transvenous removal of endocardial leads in a patient with initial contraindication for such a procedure due to the size of the vegetation in his right atrium. Simultaneously, the patient's progressive general poor condition during the course of infective endocarditis prognosed that cardiosurgical intervention with the use of cardiopulmonary bypass would be unsuccessful. Using an innovative solution, that is placing the Dotter's basket in the right ventricular outlet as a protection against massive pulmonary embolism, the leads were removed. An asymptomatic pulmonary embolism caused by defragmented vegetation was revealed after the procedure.
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Małecka et al. (2010) studied this question.
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