PMC6342614_01
Large vegetation in case 1. A: The large vegetation, measuring greater than 4 cm, as observed by intracardiac echocardiography. B: The vegetation, measuring greater than 4 cm, as observed by transesophageal echocardiography. C: Two implantable cardioverter-defibrillator leads with small amounts of thrombus and vegetation. D: Residual small amount of vegetation measuring less than 5 mm as observed by transesophageal echocardiography 1 week after lead extraction. E: Enhanced computed tomography showed no pulmonary embolism 1 week after lead extraction.
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Antibiotics and heparin infusion were prescribed for more than 1 week, without reduction in the volume of the vegetation (Figure 1A and B). Then, the ICD leads were extracted using a snare from the femoral vein (Figure 1C). One week after lead extraction with intravenous antibiotic infusion, TEE showed that the large vegetation was almost completely absent, and only a small vegetation less than 5 mm was attached at the tricuspid valve (Figure 1D). Enhanced computed tomography 1 week after lead extraction showed no pulmonary embolism (Figure 1E).
PMC6342614_02
Large vegetation in case 2. A: The large vegetation, measuring 2.7 cm, was adherent to the right ventricle (RV) lead. B: The tip of the RV lead was detached from the RV and captured by a snare from the femoral vein. C: The RV lead was extracted smoothly though the inferior vena cava, but was trapped at the femoral vein.
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He was referred to our hospital because of a large vegetation measuring 2.7 cm, which was adherent to the right ventricle (RV) lead (Figure 2A). The tip of the RV lead was detached from the RV to the RA by simple traction without advancement of any sheaths to the tricuspid valve or the RV. The lead was then captured and pulled out by a snare from the femoral vein (Figure 2B and C).
Large vegetation removed by Fogarty catheter. A: Only the large vegetation was trapped at the right femoral vein. B, C: The vegetation was extracted by Fogarty catheter (cath).
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Although the RV lead and vegetation were smoothly pulled through the inferior vena cava, the vegetation was trapped at the right femoral vein (Figure 3A). A Fogarty catheter (balloon size: diameter 11 mm) was then inserted via the femoral vein and was used to successfully remove the remaining portion of the vegetation without any complications (Figure 3B and C).