Simultaneous lead extraction and vacuum-assisted vegetation removal

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Presentation transcript:

Simultaneous lead extraction and vacuum-assisted vegetation removal Ziad F. Issa, MD, FHRS, Nilesh J. Goswami, MD HeartRhythm Case Reports Volume 2, Issue 1, Pages 17-19 (January 2016) DOI: 10.1016/j.hrcr.2015.08.008 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 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. HeartRhythm Case Reports 2016 2, 17-19DOI: (10.1016/j.hrcr.2015.08.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 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. HeartRhythm Case Reports 2016 2, 17-19DOI: (10.1016/j.hrcr.2015.08.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 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. HeartRhythm Case Reports 2016 2, 17-19DOI: (10.1016/j.hrcr.2015.08.008) Copyright © 2016 Heart Rhythm Society Terms and Conditions