title: Aspergillus infection in a large thrombus of a permanent ventricular pacing lead.
abstract: Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hee-Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Chong-Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Tai-Ho
authors.initials: TH
authors.lastname: Rho
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
authors.forename: Eun-Ju
authors.initials: EJ
authors.lastname: Cho
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: Jin
authors.forename: Hui-Kyung
authors.initials: HK
authors.lastname: Jeon
authors.forename: Jang-Seong
authors.initials: JS
authors.lastname: Chae
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Kim
authors.forename: Soon-Jo
authors.initials: SJ
authors.lastname: Hong
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Choi
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000382:microbiology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology