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J Thorac Cardiovasc Surg 2008;136:786-787
© 2008 The American Association for Thoracic Surgery

Brief Communication

Surgical extraction of cardiac resynchronization therapy system with concomitant implantation of a new system with the use of epicardial leads in a patient with endocarditis

^a First Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
^b Department of Electrocardiology, Medical University of Silesia, Katowice, Poland
^c Department of Cardiology, District Hospital, Koszalin, Poland

Received for publication October 7, 2007; accepted for publication November 21, 2007.

^_* Address for reprints: Jaroslaw Bis, MD, First Department of Cardiac Surgery, ul. Ziolowa 47, 40-635 Katowice, Poland. (Email: bisu@mp.pl).

The first 20% of the full text of this article appears below.

Endocarditis related to a transvenously implanted cardiac resynchronization therapy (CRT) system is a rare but serious therapeutic challenge, particularly in those patients in whom interruption of biventricular stimulation induces dramatic deterioration of their hemodynamic status.

Clinical Summary

We report the case of a 57-year-old man with a CRT system implanted transvenously in 2003 owing to dilative cardiomyopathy, in whom infective endocarditits with blood cultures positive for methicillin-resistant Staphylococcus epidermidis was diagnosed. The preoperative transthoracic echocardiogram revealed abnormal, moving echoes in the right atrium, impaired left ventricular ejection fraction of 20%, moderate mitral regurgitation, and severe tricuspid regurgitation. Transesophageal echocardiography confirmed the presence of two large vegetations (>1 cm in diameter) attached to the pacing leads within the right atrium (Figure 1 ). A temporary interruption of biventricular stimulation during preoperative echocardiography induced a deterioration of global systolic function, appearance of asynchrony, increase in mitral regurgitation, and after 15 minutes, signs of dyspnea and orthopnea. Consequently, the . . . [Full Text of this Article]