A Case of Infective Endocarditis with Septic Pulmonary Emboli

Takayuki Ueno Toshiyuki Yuda Hitoshi Matsumoto
Yosuke Hisashi Ryuzo Sakata

(Second Department of Surgery, Faculty of Medicine, Kagoshima University, Kagoshima, Japan and Department of Cardiovascular Surgery, Prefectural Miyazaki Hospital, Miyazaki, Japan)

A 37-year-old woman had a permanent transvenous cardiac pacemaker inserted previously in the left subclavian region to treat complete atrioventricular heart block. As infection occurred in the left subclavian subcutaneous pacemaker pocket after generator replacement, the generator was removed and a new permanent transvenous cardiac pacemaker was inserted in the right subclavian region. After two months, she developed fever and productive cough, and was admitted to our hospital. Echocardiography showed vegetation on the pacemaker electrodes and the tricuspid valve. Chest-computed tomography showed scattered bilateral peripheral nodules with various degrees of cavitation. We diagnosed right-sided infective endocarditis (IE) with septic pulmonary emboli (SPE) and performed cardiac surgery. We observed vegetation on the pacemaker electrodes and the tricuspid valve. The vegetation, the electrodes, and the generator were all removed and a permanent epicardial pacemaker was inserted subcutaneously in the left subcostal region. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from cultures of vegetation. Postoperative antibiotic therapy was performed and SPE was completely cured. We removed the pacemaker and the electrodes, and performed postoperative antibiotic therapy.@
@@Jpn. J. Cardiovasc. Surg. 31F124-127(2002)