RESUMO
BACKGROUND: Simultaneous thrombosis in more than one coronary artery is an uncommon angiographic finding in patients with acute ST-segment elevation myocardial infarction. It is difficult to identify using 12-lead electrocardiography and usually leads to cardiogenic shock and fatal outcomes, including sudden cardiac death. Therefore, immediate revascularization and adequate mechanical circulatory support are required. CASE PRESENTATION: We report the case of a 58-year-old man who presented with vomiting and chest pain complicated by cardiogenic shock and complete atrioventricular block. Electrocardiography revealed ST-segment elevation in leads II, III, aVF, and V1-V6. Emergency coronary angiography revealed total occlusion of the proximal left anterior descending artery and right coronary artery. The patient successfully underwent primary percutaneous coronary intervention with ballooning and stenting for both arteries. An Impella CP was inserted during the procedure. Fifty-seven days after admission, he had New York Heart Association class II heart failure and was transferred to a rehabilitation hospital. CONCLUSIONS: Acute double-vessel coronary thrombosis, a serious event with a high mortality rate, requires prompt diagnosis and management to prevent complications such as cardiogenic shock and ventricular arrhythmias. A combination of judicious medical treatment, efficient primary percutaneous coronary intervention, and early mechanical support device insertion is crucial to improve the survival rate of patients with this disease.
Assuntos
Trombose Coronária , Infarto do Miocárdio , Intervenção Coronária Percutânea , Arritmias Cardíacas , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapiaRESUMO
BACKGROUND: Primary cardiac neoplasms are extremely rare, with an autopsy incidence of 0.0001-0.003%. Primary cardiac sarcoma is usually derived from the right atrium and it manifests as chest pain, arrhythmia, hemoptysis, dyspnea, and fatigue. The most common target organ for metastasis of primary angiosarcoma is the lungs, but the radiological-pathological correlation has been rarely reported. CASE PRESENTATION: A 38-year-old healthy Japanese man was admitted to our hospital with persistent hemoptysis, exaggerated dyspnea, and two episodes of loss of consciousness in the past 3 months. Non-enhanced thoracic computed tomography (CT) revealed multiple scattered nodules with halo signs. Contrast-enhanced thoracic CT revealed a filling defect in the right atrium, which corresponded to the inhomogeneously enhancing tumor in the right atrium on enhanced electrocardiogram-gated cardiac CT. On day 2, acute respiratory failure occurred, and the patient was placed on mechanical ventilation. The patient was diagnosed with primary cardiac angiosarcoma based on the urgent transcatheter biopsied specimen of the right atrium mass and was treated with intravenous administration of doxorubicin. However, his respiratory status rapidly deteriorated, and he died on day 20. Postmortem biopsy showed that the multiple lung nodules with the halo signs corresponded to the intratumoral hemorrhagic necrosis and peripheral parenchymal hemorrhage in their background, suggesting the fragility of the lung tissue where the tumor had invaded, which caused hemoptysis. Furthermore, two episodes of loss of consciousness occurred probably due to a decreased cardiac output because of a massive tumor occupying the right atrium, recognized as an inhomogeneous centripetal enhancement on enhanced electrocardiogram-gated cardiac CT. CONCLUSIONS: This case clearly demonstrated that primary cardiac angiosarcoma could expand in the right atrial cavity, which led to a decreased cardiac output resulting in repeated syncope, together with the fragility of lung tissue by tumor invasion, thereby generating a halo sign on thoracic CT.
Assuntos
Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Adulto , Biópsia , Diagnóstico Diferencial , Evolução Fatal , Hemangiossarcoma/secundário , Hemoptise/etiologia , Hemorragia/etiologia , Humanos , Neoplasias Pulmonares/secundário , Masculino , Tomografia Computadorizada por Raios XRESUMO
An expandable polytetrafluoroethylene (ePTFE) covered stent is generally employed to seal coronary artery perforation. The frequency of ePTFE covered stent use is relatively low; thus, only a handful of studies have reported neointimal coverage and endothelialization inside the deployed ePTFE and clinical time course after ePTFE implantation. This case report presents a 78-year-old man treated with an ePTFE covered stent when he suffered from coronary artery perforation after the implantation of two everolimus eluting stents in the left anterior descending artery. Follow-up coronary angiography 9 months after ePTFE covered stent implantation depicted favorable stent patency. Optical coherence tomography showed thin and uneven stent strut coverage at the culprit. Angioscopy also depicted partial white-coated coverage and stent strut exposure. The outcome of this case suggested that long-term dual antiplatelet therapy should be prescribed for preventing thrombosis after ePTFE covered stent implantation.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Vasos Coronários/lesões , Stents Farmacológicos/efeitos adversos , Neointima/diagnóstico por imagem , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioscopia , Angiografia Coronária , Vasos Coronários/cirurgia , Everolimo/administração & dosagem , Humanos , Masculino , Infarto do Miocárdio/cirurgia , Desenho de Prótese , Tomografia de Coerência ÓpticaRESUMO
Stent placement for treating superficial femoral artery (SFA) lesions has been approved. The Zilver PTX stent, a drug-eluting stent (DES) for treating SFA lesions, has been available in Japan since 2012. However, the penetration rate of this DES has not yet been reported. This prospective multicenter registry study enrolled 314 patients (354 limbs) to be treated by stent placement in 2014 (UMIN000011551). The primary endpoint was the measurement of the penetration rate of the DES. The secondary endpoints were measuring the freedom from restenosis, freedom from target lesion revascularization (TLR), freedom from major adverse limb event (MALE), and the survival rate at 12 months postoperatively. Female patients comprised 28% participants. The mean age was 73.1 ± 9.2 years. A total of 56% patients had diabetes mellitus (DM), 36% patients were receiving hemodialysis, and 30% used cilostazol at baseline. The mean lesion length was 156 ± 101 mm, and the percentage of TASC II C/D lesions was 58%. Critical limb ischemia (CLI) was observed in 32% limbs. The penetration rates of the Zilver PTX stent were only 8%. The primary patency rate was similar between DES and bare-metal stents (BMS) at 12 months postoperatively (77 vs. 84%, p = 0.52). In this study, the rates of freedom from restenosis, freedom from TLR, freedom from MALE, and the survival rate at 12 months postoperatively were 83, 86, 85, and 89%, respectively. The penetration rate of a first-generation DES placement for treating SFA lesions is low in Japan. On the other hand, BMS is well utilized and its primary patency is acceptable.
Assuntos
Stents Farmacológicos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Grau de Desobstrução Vascular , Idoso , Intervalo Livre de Doença , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Estudos Prospectivos , Desenho de Prótese , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
OBJECTIVE: To describe co-existence of left heart abnormalities among case series of connective tissue disease (CTD) patients who showed pre-capillary pulmonary hypertension (PH) as well as borderline mean pulmonary arterial pressure (mPAP). METHODS: From 2010 through 2012, 49 CTD patients suspected to have PH by exercise Doppler echocardiography underwent right heart catheterization. We retrospectively searched for left heart diseases from the available data on Doppler echocardiography, cardiac magnetic resonance imaging (MRI), scintigraphy, and endomyocardial biopsy. RESULTS: Among 49 patients, 11 and 2 had pre- and post-capillary PH, respectively, and another 10 had borderline mPAP. Six of 11 patients with pre-capillary PH showed low pulmonary vascular resistance (PVR) (≤ 240 dynesâ¢secâ¢cm(- 5)) and low diastolic pulmonary gradient (< 7 mmHg). Seven of 10 patients with borderline mPAP had normal PVR (< 160) suggesting the presence of left heart abnormalities. Other abnormal findings included increased left atrial volume index and E/E' on Doppler echocardiography, delayed contrast enhancement by MRI, patchy area of hypoperfusion on thallium scintigraphy, and fibrosis in endomyocardial biopsy. CONCLUSION: The present case series suggested some contribution of left heart abnormalities to the increase in mPAP among CTD patients with pre-capillary PH as well as borderline mPAP.
Assuntos
Doenças do Tecido Conjuntivo/complicações , Ventrículos do Coração/anormalidades , Hipertensão Pulmonar/complicações , Disfunção Ventricular Esquerda/congênito , Adulto , Idoso , Pressão Arterial , Cateterismo Cardíaco , Doenças do Tecido Conjuntivo/diagnóstico , Ecocardiografia Doppler , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resistência Vascular/fisiologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda/fisiologiaRESUMO
Intramural hematoma after percutaneous coronary angioplasty is associated with adverse events and requires immediate bail out; however, the optimal treatment approach has not yet been established. Herein, we describe a case of coronary occlusion due to an intramural hematoma following stent implantation in the mid left anterior descending (LAD) coronary artery. Intravascular ultrasound revealed a massive intramural hematoma from the distal edge of the stent to the distal segment of the LAD, and the true lumen was completely compressed. By performing fenestration with a Wolverine™ Cutting Balloon™ (Boston Scientific, Massachusetts, United States), we were able to bail out without additional stenting. In conclusion, a cutting balloon with improved crossability can be an effective management strategy for intramural hematoma.
Assuntos
Angioplastia Coronária com Balão , Doenças Vasculares , Angioplastia Coronária com Balão/efeitos adversos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , StentsRESUMO
BACKGROUND: Contrast-induced acute kidney injury is one of the common adverse events related to percutaneous coronary intervention and a predictor for worse outcome. In the setting of percutaneous coronary intervention for chronic total occlusion, large amounts of contrast medium, more than 200-400 mL, are generally injected. A higher dose of contrast medium causes contrast-induced acute kidney injury more frequently. Therefore, patients who undergo chronic total occlusion-percutaneous coronary intervention are at risk for contrast-induced acute kidney injury. CASE PRESENTATION: We present the case of a 77-year-old Japanese man with post-acute myocardial infarction angina pectoris, heart failure, and chronic kidney disease who underwent percutaneous coronary intervention for chronic total occlusion in his right coronary artery. In the procedure, the retrograde wire was a visible penetration mark that made contrast medium unnecessary. Contemporary reverse controlled antegrade and retrograde subintimal tracking was successfully achieved and stents were implanted without contrast medium. Contrast medium was injected two times after stent implantation to confirm coronary flow and no perforation. The total amount of contrast medium was only 8 mL for chronic total occlusion-percutaneous coronary intervention. CONCLUSION: Chronic total occlusion-percutaneous coronary intervention with contemporary reverse controlled antegrade and retrograde subintimal tracking without contrast medium may be safe and feasible in selected patients.
Assuntos
Angina Pectoris/cirurgia , Angiografia Coronária , Oclusão Coronária/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Radiografia Intervencionista , Idoso , Angina Pectoris/fisiopatologia , Meios de Contraste , Humanos , Masculino , Infarto do Miocárdio/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Minimally invasive percutaneous transluminal renal artery stenting (MIPTRS) is a method that prevents complications to the greatest extent possible. The present study aimed to investigate the safety and efficacy of MIPTRS performed in cases of renal artery stenosis with an estimated glomerular filtration rate (eGFR)≤45mL/min. METHODS: Cases of patients who underwent MIPTRS at our hospital between December 2010 and June 2015 in whom eGFR was ≤45mL/min were retrospectively analysed. MIPTRS was performed as follows: 1) using a 4Fr sheathless guiding catheter in a trans-radial approach and 2) using a guiding catheter non-touch technique. The amount of contrast agent used was maintained at ≤10mL with 3) carbon dioxide enhancement and 4) intravascular ultrasound guide stenting, and 5) a distal protection device was used. RESULTS: MIPTRS was performed in 22 patients (32 lesions). The pre-MIPTRS creatinine level and eGFR were 2.01±0.88mg/dL and 29.2±9.0mL/min/1.73m2, respectively. On postoperative day 2, they were 1.78±0.73mg/dL and 35.1±12.3mL/min/1.73m2; at 1month after the procedure, they were 1.80±0.74mg/dL and 33.3±12.3mL/min/1.73m2. Creatinine level did not change significantly, but eGFR was significantly elevated after versus before the procedure, both 2days later (p<0.01) and 1month later (p<0.05). CONCLUSION: The results of this study demonstrated the usefulness of MIPTRS for protecting renal function. This method can be safely used in patients with decreased renal function.
Assuntos
Angioplastia/métodos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/cirurgia , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos RetrospectivosRESUMO
BACKGROUND: We propose the use of aortic annulus displacement (AAD) detected on contrast left ventriculography (LVG) during invasive coronary angiography as a marker of left ventricular (LV) long-axis shortening. In the present study, we aimed to investigate whether AAD is associated with adverse events in patients who underwent coronary angiography because of suspected coronary artery disease. METHODS: In this retrospective study, we evaluated the medical records of 998 consecutive patients who underwent invasive coronary angiography and LVG. LV lengths were measured from the apex to the aortic valve insertion by using LVG images. AAD (%) was calculated as [(LV end-diastolic length-LV end-systolic length)/LV end-diastolic length]×100. RESULTS: The participants' median age was 67 years. Ninety-six adverse events (composite events; all-cause death, 39; congestive heart failure, 21; late revascularization, 34; and myocardial infarction, 2) were observed during a median follow-up period of 3.1 years. In multivariate Cox regression analysis, adverse events were associated with lower AAD (hazard ratio, 0.703; p=0.002), after adjusting for traditional risk factors and coronary artery stenosis. The area under the curve of AAD for predicting adverse events was greater than that of LV ejection fraction (0.656 vs. 0.541, p<0.05). CONCLUSIONS: AAD was superior to LV ejection fraction as a predictor of adverse events in patients with and without coronary arterial stenosis. AAD may be the optimal method for assessing longitudinal LV systolic function in the catheter laboratory.
Assuntos
Valva Aórtica/diagnóstico por imagem , Angiografia Coronária , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Idoso , Meios de Contraste , Doença da Artéria Coronariana/diagnóstico por imagem , Diástole , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , SístoleRESUMO
Longitudinal measurement using intravascular ultrasound is limited because the motorized pullback device assumes no cardiac motion. A newly developed intracoronary imaging modality, optical frequency domain imaging (OFDI), has higher resolution and an increased auto-pullback speed with presumably lesser susceptibility to cardiac motion artifacts during pullback for longitudinal measurement; however, it has not been fully investigated. We aimed to clarify the influence of cardiac motion on the accuracy and reproducibility of longitudinal measurements obtained using OFDI and to determine the optimal pullback speed. This ex vivo study included 31 stents deployed in the mid left anterior descending artery under phantom heartbeat and coronary flow simulation. Longitudinal stent lengths were measured twice using OFDI at three pullback speeds. Differences in stent lengths between OFDI and microscopy and between two repetitive pullbacks were assessed to determine accuracy and reproducibility. Furthermore, three-dimensional (3D) reconstruction was used for evaluating image quality. With regard to differences in stent length between OFDI and microscopy, the intraclass correlation coefficient values were 0.985, 0.994, and 0.995 at 10, 20, and 40 mm/s, respectively. With regard to reproducibility, the values were 0.995, 0.996, and 0.996 at 10, 20, and 40 mm/s, respectively. 3D reconstruction showed a superior image quality at 10 and 20 mm/s compared with that at 40 mm/s. OFDI demonstrated high accuracy and reproducibility for longitudinal stent measurements. Moreover, its accuracy and reproducibility were remarkable at a higher pullback speed. A 20-mm/s pullback speed may be optimal for clinical and research purposes.
Assuntos
Circulação Coronária , Vasos Coronários/fisiopatologia , Intervenção Coronária Percutânea/instrumentação , Fluxo Pulsátil , Stents , Tomografia de Coerência Óptica/métodos , Artefatos , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Microscopia , Modelos Anatômicos , Modelos Cardiovasculares , Imagens de Fantasmas , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/instrumentaçãoRESUMO
Microvascular angina is a rare condition in which myocardial ischemia is caused by microvascular dysfunction without any abnormalities of the epicardial coronary arteries. In clinical practice, it is difficult to diagnose because the microvascular alterations cannot be detected by conventional angiography. Herein we present a rare case of a 67-year-old woman with unstable angina pectoris in whom considerably slow coronary flow was induced by the acetylcholine provocation test with mild epicardial arterial spasm, suggesting the presence of microvascular spasm. Moreover, we show that ß-methyl-p-[(123)I]-iodophenyl-pentadecanoic ((123)I-BMIPP) single-photon emission computed tomography imaging is useful for proving myocardial ischemia.
Assuntos
Acetilcolina/administração & dosagem , Circulação Coronária/efeitos dos fármacos , Vasoespasmo Coronário/diagnóstico , Vasos Coronários/fisiopatologia , Microcirculação , Fluxo Sanguíneo Regional/fisiologia , Idoso , Vasoespasmo Coronário/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/efeitos dos fármacos , Feminino , Humanos , Injeções Intra-Arteriais , Radiografia , Vasodilatadores/administração & dosagemRESUMO
INTRODUCTION: The relationship between plaque morphology detected by optical coherence tomography (OCT) and inflammatory biomarkers is not well known. MATERIAL AND METHODS: This study included 47 patients with ischemic heart disease (22 patients with acute coronary syndrome and 25 patients with effort angina pectoris) who underwent percutaneous coronary intervention (PCI). Before PCI, peripheral blood levels of the inflammatory biomarkers high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured. The OCT can detect thin-cap fibroatheroma (TCFA), a lesion with high potential for adverse cardiac events. We investigated the relationships between TCFAs in culprit lesions detected by OCT and the peripheral blood levels of these biomarkers. RESULTS: We observed 12 lesions detected as TCFAs. The natural logs of hs-CRP and IL-6 levels in the TCFA group were higher than those in the non-TCFA group (hs-CRP 0.87 (-0.96 to 0.87) vs. -0.47 (-0.92 to 0.30) mg/l, p = 0.027; and IL-6 1.63 (0.63-3.23) vs. 0.53 (-0.21 to 1.05) pg/dl, p = 0.005, respectively). In multivariate logistic regression analysis, log IL-6 was an independent predictor for TCFA detected by OCT (log IL-6, 0.970 pg/dl, p = 0.023). Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively). CONCLUSIONS: Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT. Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.
RESUMO
PURPOSE: We evaluated the influence of early defects (EDs) in the infarcted myocardium after reperfusion, detected by computed tomography angiography (CTA), on cardiac function and exercise capacity in the chronic phase. MATERIALS AND METHODS: We retrospectively analyzed 48 acute myocardial infarction (AMI) patients who underwent both CTA using 64-slice multidetector CT within 14 ± 6 days and cardiopulmonary exercise testing within 3 months after AMI onset between 2005 and 2007. The patients were divided into 2 groups: the EDs <75 % or EDs ≥75 % group. Brain natriuretic peptide (BNP) levels and ejection fraction (EF) were measured 6 months after AMI onset. RESULTS: The minute ventilation-carbon dioxide production slope was significantly higher in the EDs ≥75 % group (28.7 ± 4.9) than in the EDs <75 % group (25.1 ± 3.1, P = 0.048). EF at 6 months was significantly lower in the EDs ≥75 % group (48.1 ± 12.0 %) than in the EDs <75 % group (56.8 ± 10.0 %, P = 0.01). Log of BNP levels was higher in the EDs ≥75 % group than in the EDs <75 % group (P < 0.001). CONCLUSION: EDs detected by CTA in the acute phase of AMI influenced myocardial dysfunction and exercise intolerance in the chronic phase.
Assuntos
Vasos Coronários/diagnóstico por imagem , Tolerância ao Exercício/fisiologia , Infarto do Miocárdio/complicações , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Esquerda/complicações , Doença Aguda , Idoso , Meios de Contraste , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Peptídeo Natriurético Encefálico/sangue , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos , Tempo , Disfunção Ventricular Esquerda/sangueAssuntos
Angioplastia Coronária com Balão/efeitos adversos , Trombose Coronária/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Complicações Pós-Operatórias , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Trombose Coronária/diagnóstico , Anomalias dos Vasos Coronários/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Seguimentos , Humanos , Remissão Espontânea , Fatores de Tempo , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologiaRESUMO
The patient was a 67-year-old male who received implantable cardioverter defibrillator (ICD) due to dilated cardiomyopathy and ventricular tachycardia 10 years previously. In September 2007, he was admitted to our hospital for dilated cardiomyopathy accompanied by congestive heart failure. Since he suffered from pneumonia and respiratory insufficiency, he was treated with steroid, long-term artificial respirator, and central venous catheter placement. Congestive heart failure and pneumonia improved; however, he was diagnosed as having ICD lead infection and infective endocarditis because of a positive blood culture for methichillin-resistant Staphylococcus aureus (MRSA). After 2 months of appropriate anti-MRSA agent administration, the ICD lead was surgically removed and his tricuspid valve was replaced. The postoperative course was uneventful; a cardiac resynchronization therapy defibrillator (CRT-D) was reimplanted 6 weeks after lead extraction. We experienced a case with long-term ICD lead infection and lead-related infective endocarditis in the tricuspid valve caused by MRSA in a patient with poor cardiac function, which is the first successful case in Japan.