Key result
Laser-assisted extraction successfully removes an infected ICD lead with massive vegetation despite uncomplicated pulmonary infarction.
Case Report (n=1)
Laser-assisted extraction of an ICD lead with a very large vegetation (>500 mm2) can be performed successfully, though it may result in asymptomatic pulmonary embolism.
Supports feasibility of laser extraction for massive vegetations; hypothesis-generating and should not yet change practice.
Infective endocarditis involving transvenous pacing leads is an uncommon but potentially lethal complication of implantable cardioverter-defibrillator (ICD) implantation. Complete removal of the device and the leads is presently considered to be the optimal treatment in such patients and laser-assisted lead removal is an effective and safe nonthoracotomy approach. However, large vegetations (>10 mm) attached to the lead limit nonthoracotomy explantation because of the potential for hemodynamically embarrassing pulmonary embolization. Laser extraction of leads with vegetation area >300 mm2 has rarely been reported. In this case report, we describe a patient with an infected ICD lead with vegetation greater than 41 x 12.5 mm (512 mm2) in size that was explanted with laser-assistance. The resulting pulmonary embolus produced a 33 x 20 mm pulmonary infarction without hemodynamic or respiratory compromise.
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Calton et al. (2006) conducted a case report in Infected ICD lead with a large vegetation (n=1). Laser-assisted lead removal was evaluated on Successful explantation and clinical outcome. Laser-assisted extraction of an infected ICD lead with a massive vegetation (512 mm2) was successful, resulting in a pulmonary infarction without hemodynamic or respiratory compromise.
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