Eustachian valve endocarditis diagnosed by transoesophageal echocardiography

Pacemaker lead infection is a rare condition, most often occurring when intervention is needed after pacemaker implantation.Diagnosis is by blood cultures and confirmation by transoesophageal echocardiography; transthoracic echocardiography is often inadequate.A literature review indicated the microorganism most responsible for late lead infection is Staphylococcus epidermidis (which can grow on plastic material).A retrospective analysis of patient files from the authors' institution (1993-97) yielded three patients with proven pacemaker lead endocarditis.The diagnosis of pacemaker endocarditis was by transoesophageal echocardiography.The endocarditis appeared after a long period and in two of the three patients there was S epidermidis infection.Thoracotomy with removal of the infected system was performed because of the large dimensions of the vegetations.A new pacemaker was implanted: in one patient with endocardial leads, in the other two with epicardial leads.All three patients recovered well and follow up was uneventful for at least one year.