Sato Takumi, Osawa Takumi, Ochi Akinori, Fumikura Yuko, Machino-Ohtsuka Tomoko, Yamasaki Hiro, Ishizu Tomoko, Nishina Hidetaka
Department of Cardiology, Tsukuba Medical Center Hospital, Japan.
Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan.
Intern Med. 2025 May 15;64(10):1542-1546. doi: 10.2169/internalmedicine.3937-24. Epub 2024 Oct 4.
An 85-year-old man with a history of 2 open-heart surgeries [for aortic regurgitation and infective endocarditis (IE)] and pacemaker implantation for bradycardic atrial fibrillation presented with a fever. Transesophageal echocardiography revealed a pacemaker lead vegetation. Computed tomography showed a retrosternal abscess. He was diagnosed with acute heart failure and IE. Given the high surgical risk due to his age, acute heart failure, and surgical history, we decided against cardiac surgery. After lead extraction, a leadless pacemaker was inserted, and antimicrobial therapy was administered. The patient was discharged on day 48, highlighting a strategy for managing complex cardiac device-related IE.
一名85岁男性，有2次心脏直视手术史（因主动脉瓣反流和感染性心内膜炎[IE]），因缓慢性心房颤动植入起搏器，现出现发热。经食管超声心动图显示起搏器导线赘生物。计算机断层扫描显示胸骨后脓肿。他被诊断为急性心力衰竭和IE。鉴于其年龄、急性心力衰竭和手术史导致的高手术风险，我们决定不进行心脏手术。在拔除导线后，植入了无导线起搏器，并给予抗菌治疗。患者于第48天出院，突出了一种管理复杂心脏装置相关IE的策略。
