PMC5412662_01
Transesophageal echocardiography showing a large vegetation (arrows) measuring 46 25 mm attached to the implantable cardioverter-defibrillator right ventricular lead at the level of the tricuspid valve. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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Tendril 1888TC) 4 years ago presented with a 1-week history of flu-like symptoms, fever, and chills. She was found to have persistent Streptococcus bovis bacteremia. Transesophageal echocardiography showed a large, mobile mass measuring 46 x 25 mm attached to the ICD right ventricular lead at the level of the tricuspid valve (Figure 1).
Fluoroscopy images (anteroposterior view) during simultaneous vegetation removal and lead extraction. A: The AngioVac cannula is positioned at the low right atrium (RA). The EN Snare is used to debulk the vegetation off the right ventricular implantable cardioverter-defibrillator lead (RV), under transesophageal echocardiography (TEE) guidance. B: Once the RV lead tip is freed with countertraction during laser extraction, a 20 mm gooseneck snare is used to "strip" the lead from attached vegetations. C: Lead extraction was completed while AngioVac suction was active. LV = left ventricular lead.
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Using the EN Snare endovascular snare system (Merit Medical, South Jordan, UT), a large vegetation was removed under transesophageal echocardiography guidance (Figure 2; Movie 1, available online) and then pulled back to the AngioVac device, where it was successfully suctioned off and removed and trapped in the filter (Figure 3). The snare was then tightened on the lead and moved toward the lead tip to "strip" the lead from attached vegetations (Figure 2B; Movie 2, available online).
A: AngioVac filter filled with pieces of the vegetations suctioned via the AngioVac cannula. B: Vegetation removed from the AngioVac filter. C: The extracted implantable cardioverter-defibrillator right ventricular lead.
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Using the EN Snare endovascular snare system (Merit Medical, South Jordan, UT), a large vegetation was removed under transesophageal echocardiography guidance (Figure 2; Movie 1, available online) and then pulled back to the AngioVac device, where it was successfully suctioned off and removed and trapped in the filter (Figure 3).