ABSTRACT
Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.
Subject(s)
Defibrillators, Implantable , Heart Diseases , Pacemaker, Artificial , Prosthesis-Related Infections , Humans , Defibrillators, Implantable/adverse effects , Delayed Diagnosis/adverse effects , Heart Diseases/complications , Device Removal/adverse effects , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/therapyABSTRACT
We report a rare case of a massive 7- x 3.25-cm thrombus in the left ventricle of a 25-year-old man. He presented with a subacute febrile illness for 1 month with a sudden worsening respiratory distress and chest pain. His initial evaluation in the emergency department diagnosed an interstitial lung process. Two-dimensional echocardiography demonstrated a previously undiagnosed cardiomyopathy and a massive left ventricular thrombus.
Subject(s)
Cardiomyopathies/diagnostic imaging , Heart Ventricles/diagnostic imaging , Thrombosis/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Cardiomyopathies/complications , Diagnosis, Differential , Echocardiography, Doppler , Humans , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnostic imaging , Male , Thrombosis/complications , Ventricular Dysfunction, Left/etiologyABSTRACT
We report a rare case of mitral regurgitation as a result of perivalvular leak in a 49-year-old man with a history of blunt trauma. He presented with a 2-month history of progressive exertional dyspnea, angina, and heart failure. Preoperative transesophageal echocardiography demonstrated severe mitral regurgitation as a result of a perivalvular leak of the mitral valve that was not evident on transthoracic echocardiography and cardiac catheterization.
Subject(s)
Chordae Tendineae/injuries , Heart Injuries/complications , Mitral Valve Insufficiency/etiology , Wounds, Nonpenetrating/complications , Accidents, Traffic , Angina Pectoris/diagnostic imaging , Angina Pectoris/etiology , Chordae Tendineae/diagnostic imaging , Chronic Disease , Disease Progression , Dyspnea/diagnostic imaging , Dyspnea/etiology , Echocardiography , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Failure/diagnostic imaging , Heart Failure/etiology , Heart Injuries/diagnostic imaging , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/etiology , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/etiology , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
Transesophageal echocardiography (TEE) is an excellent method for visualizing pathology of the mediastinum. We present a case in which TEE detected an unsuspected lymphoma posterior to the descending thoracic aorta in a man suspected of having endocarditis. This case illustrates the advantages of TEE over transthoracic echocardiography in examining the mediastinum and the importance of performing a complete TEE examination.
