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Video 1 Transthoracic echocardiogram after lead extraction
Video 2 Three-dimensional evaluation of mass in transthoracic echocardiogram after lead extraction
Opmerkingen
Video online
The online version of this article contains two videos. The article and the videos are online available (https://doi.org/10.1007/s12471-022-01754-z). The videos can be found in the article back matter as “Electronic Supplementary Material”.
A 49-year-old man with a history of familial amyloidotic polyneuropathy was admitted to the hospital because of device-related endocarditis. He had undergone a liver transplant and placement of a single-chamber pacemaker 19 years earlier. After transvenous right ventricular lead extraction (LE), transthoracic echocardiography revealed a hyperechogenic, filiform, anomalous mass of 8 × 5 mm (Fig. 1, and see Videos 1 and 2 in Electronic Supplementary Material). The mass was located along the removed lead’s intracardiac route; one end of the mass was attached to the right ventricular wall and the other end was located below the tricuspid valve and had a very mobile tip. An interventional report and an X‑ray confirmed complete LE. The mass was interpreted as a thick, fibrous, tubular encasement of the lead that persisted after extraction, also known as ‘ghost’. A conservative approach was followed. Blood cultures were persistently negative, and the patient remained asymptomatic during subsequent follow-up.
Fig. 1
Transthoracic echocardiography. a Four-chamber right-ventricle focused view showing hyperechogenic, filiform, anomalous mass (8 × 5 mm), with mobile tip curving inside tricuspid valve. b Four-chamber view showing attachments of mass to right ventricular wall and below tricuspid valve
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The presence of ‘ghosts’ is associated with a poor prognosis after LE, but the best approach for patients with this finding remains unclear. To prevent complications such as recurrent infective endocarditis or embolic events, close follow-up is needed [1].
Conflict of interest
V. Neto, J. Santos, N. Craveiro, L. Santos and M. Correia declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
