Madden George, Farrukh Omar, Stavrakis Stavros, Sivaram C A
Department of Medicine/Cardiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Echocardiography. 2014 Sep;31(8):E247-9. doi: 10.1111/echo.12651. Epub 2014 Jun 11.
A 57-year-old male with a dual chamber pacemaker and symptomatic, persistent atrial fibrillation (AF) accompanying a febrile illness presented for elective transesophageal echocardiography (TEE)-guided cardioversion. The patient was found to have a large 2.5 cm × 2.3 cm, mobile mass attached to the right atrial lead. Following device and lead extraction, he developed progressive shortness of breath which was attributed to his underlying arrhythmia. One month later, AF ablation was pursued and preablation TEE revealed a dilated main pulmonary artery with a 1.8 cm × 1.6 cm mass in the distal left pulmonary artery, which was corroborated by a 1.4 cm × 2.5 cm filling defect in the descending left pulmonary artery on magnetic resonance angiography (MRA). To our knowledge, this is the first case report to document the distal migration of vegetation material into the pulmonary artery with serial TEE and highlights the risk of pulmonary embolism (PE) in patients with large endocardial lead vegetations undergoing transvenous lead extraction.
一名57岁男性，植入双腔起搏器，伴有发热性疾病，患有症状性、持续性心房颤动（AF），前来接受择期经食管超声心动图（TEE）引导下的心脏复律。该患者被发现右心房电极上附着一个2.5厘米×2.3厘米的大型活动肿物。在取出装置和电极后，他出现进行性气短，这归因于其潜在的心律失常。一个月后，进行了房颤消融术，消融术前TEE显示主肺动脉扩张，左肺动脉远端有一个1.8厘米×1.6厘米的肿物，磁共振血管造影（MRA）显示左肺下动脉有一个1.4厘米×2.5厘米的充盈缺损，证实了这一点。据我们所知，这是第一例通过系列TEE记录赘生物物质向肺动脉远端迁移的病例报告，并强调了接受经静脉电极拔除术的大型心内膜电极赘生物患者发生肺栓塞（PE）的风险。
