Ehokardiografija u otkrivanju endokarditisa izazvanog ugradnjom elektrode implantabilnog kardioverter defibrilatora: prikaz slučaja

Abstract

Lead endocarditis is an infrequent but potentially lethal complication of implantable cardioverter defibrillator (ICD) implantation. We report a case of a 53-year-old man with ICD who was admitted to our hospital because of fever, chills, shivering, headache and malaise. Transthoracic echocardiography detected a structure highly suspect of vegetation located on the ICD lead. Transesophageal echocardiography showed a 20x12 mm mobile vegetation attached to the ICD lead in the right atrium. The infection was caused by methicillin-resistant Staphylococcus epidermidis (MRSE), which was isolated from blood cultures. Treatment consisted of surgical removal of the ICD lead and placement of new epicardial ICD leads. Three years afterwards, the patient remained asymptomatic. To our knowledge, this is the first such case reported from Croatia.Endokarditis elektrode je rijetka no potencijalno smrtonosna komplikacija ugradnje implantabilnog kardioverter defibrilatora (ICD). Prikazujemo slučaj 53 godine starog muškarca s implantiranim ICD-om koji je hospitaliziran zbog febriliteta, groznice, tresavice i općeg lošeg stanja. Transtorakalnim ultrazvukom srca je otkrivena tvorba vrlo sumnjiva na vegetaciju na elektrodi ICD-a, da bi transezofagusnim ultrazvukom bila prikazana vegetacija veličine 20x12 mm pričvršćena za elektrodu ICD-a u desnom atriju. Uzročnik endokarditisa je bio meticilin rezistentni Staphylococcus epidermidis (MRSE) koji je izoliran u hemokulturi. Liječenje se sastojalo od kirurškog odstranjenja elektrode ICD-a i njene zamjene novim, epikardijalnim elektrodama. Tri godine kasnije bolesnik je i dalje bez tegoba. Prema našim saznanjima, ovo je prvi ovakav slučaj dosad opisan u Hrvatskoj