P503The value of echocardiography in detecting the residual fibrotic tissue after transvenous leads extraction


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Abstract

Purpose: Transvenous lead extraction (TLE) is safe and effective procedure with <1 % mortality (cardiosurgery 10%). The most common indications for TLE included non-infective ( damaged or needless leads, venous occlusion and a new implantation necessity, 52%) and infective: local pocket infection (29%) and lead dependent infective endocarditis (LDIE) (19%). Transthoracic echocardiography (TTE) is of limited value and transesophageal echocardioghraphy (TEE) is diagnostic method of choice before and after lead extraction. TEE before TLE shows right heart chambers leads course, the degree of tricuspid regurgitation (TR), vegetations in patients with LDIE. TEE after TLE shows actual TR degree, sometimes persisted fibrotic tissue covering cardiac leads before or vegetations connected with right heart structures.Methods: TLE using mechanical system (mainly polypropylene telescopic Byrd dilators – Cook Pacemaker Corporation) was performed. We included patients with pre- and postoperative TEE (SONOS 5500, Andover,MA,Philips, multiplane TEE probe). This group consisted of 72 patients (M-52, F-20, aged 56 (23-85). TLE was performed without any serious complications.Results: In 18 pts (25%) we found residual tissue, “strip” looking and free floating in right atrium, beginning in vena cava superior (SVC ) ostium [3, 2 cm long (0,7-8,3 cm) and 0,3 wide (0,2-0,4 cm)]. In 9 pts ( 12 %) small tissue strips below 1 cm long and 0,3 cm wide in various right atrial areas were present. In 14 pts (20%) small vegetations persisted after TLE. From clinical point of view all these findings were of no significance. These structures reflected previous leads course in right heart chambers.Conclusions: 1.Floating fibrous tissue near SVC ostium after TLE is most common finding (25%) and reflects leads course before the procedure. 2.TEE before TLE is necessary for comparison purposes. 3 TEE after TLE is imaging of choice for visualization fibrotic remnants. 4.TEE permits differentiation of fibrotic tissue from other cardiac masses to avoid potential cardiac surgery in the future for this misleading finding.

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