|A Case of Infective Endocarditis
with Septic Pulmonary Emboli
(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
@@Jpn. J. Cardiovasc. Surg. 31F124-127(2002)