Ampatzidou Fotini C, Sileli Maria N, Koutsogiannidis Charilaos-Panagiotis C, Ananiadou Olga G, Madesis Athanasios A, Michaelidis Vassilis G, Drossos George E
Respir Care. 2014 Aug;59(8):E110-4. doi: 10.4187/respcare.02907.
Pacemaker endocarditis has a high rate of morbidity and mortality and is associated with substantial health-care cost. To maximize the effectiveness of treatment, diagnosis of pacemaker endocarditis should be made as early as possible. Medical treatment alone is not successful, and the removal of the entire artificial pacing system is often required. We present a case of a female patient with a permanent transvenous pacemaker, recurring episodes of fever and chills, general malaise, and a computed tomography image of a solitary tumor-like lesion indicating pneumonia. The symptoms subsided with empirical antibiotics but without improvement in the radiologic images. A wedge resection of the lesion by thoracotomy was performed, revealing a necrotic lung lesion compatible with pulmonary infarct. Transesophageal echocardiography showed a mass that was adherent to the pacemaker lead. The therapeutic approach consisted of surgical removal of the complete pacing system along with long-term antibiotic therapy and implantation of a new device with an epicardial lead. Serial follow-up echocardiograms for a 1-y period did not show any recurrence, and the subsequent course was uneventful.
起搏器心内膜炎具有较高的发病率和死亡率，并与高昂的医疗费用相关。为使治疗效果最大化，应尽早诊断起搏器心内膜炎。仅药物治疗往往无法成功，通常需要移除整个人工起搏系统。我们报告一例患有永久性经静脉起搏器的女性患者，反复出现发热、寒战、全身不适，计算机断层扫描图像显示有一个孤立的肿瘤样病变提示肺炎。症状经经验性抗生素治疗后缓解，但影像学图像并无改善。通过开胸手术对病变进行楔形切除，结果显示为与肺梗死相符的坏死性肺病变。经食管超声心动图显示有一个附着在起搏器导线上的肿物。治疗方法包括手术移除整个起搏系统、长期抗生素治疗以及植入带有心外膜导线的新装置。连续1年的随访超声心动图未显示任何复发情况，后续病程平稳。
