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Vol. 35. Issue 4.
Pages 241-242 (April 2016)
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Vol. 35. Issue 4.
Pages 241-242 (April 2016)
Image in Cardiology
Open Access
Externalized biventricular implantable cardioverter-defibrillator
Cardioversor-desfibrilhador com ressincronização cardíaca externa
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Sofia Lázaro Mendes
Corresponding author
sofialazaromendes@gmail.com

Corresponding author.
, Joana Moura Ferreira, Domingos Ramos, Mariano Pêgo
Cardiology Department, Coimbra University Hospital and Medical School, Coimbra, Portugal
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A 52-year-old man presented to the emergency department with externalization of a biventricular implantable cardioverter defibrillator (Figure 1). He had been admitted six months earlier with a fistula surrounding the device but left the hospital against medical advice before treatment. At admission to the emergency room his heart rate was 105 beats/min and his blood pressure was 122/96 mmHg. Cardiac auscultation revealed a systolic murmur at the apex; there were no breath sounds at the right lung base and lower limb edema was observed.

Figure 1.

Externalization of biventricular implantable cardioverter-defibrillator.

(0.23MB).

Three sets of blood cultures were drawn before antimicrobial therapy with vancomycin was begun. Methicillin-resistant Staphylococcus aureus was subsequently isolated. Transthoracic and transesophageal echocardiography were performed and a mass was seen adhering to the lead (Figures 2 and 3). Complete device and lead removal was performed within two days. The patient received parenteral antimicrobial therapy for four weeks and a new device was implanted on the contralateral side before discharge.

Figure 2.

Transthoracic echocardiogram, apical 4-chamber view, showing thickening of the lead.

(0.07MB).
Figure 3.

Transesophageal echocardiogram, showing a mass adhering to the lead.

(0.11MB).
Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2016. Sociedade Portuguesa de Cardiologia
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