title: Patent foramen ovale. Correct route for implantation of a biventricular permanent pacemaker?
abstract: BACKGROUND
  Intentional or unintentional placement of a pacemaker lead into the left ventricle is an uncommon clinical entity that is associated with a high risk for systemic embolization and enormous difficulties in case of explantation. Unintentional implantation through a patent foramen ovale via the mitral valve is the usual pathway for this malposition.
  
  
  METHODS
  We report a case where a pacemaker lead was placed intentionally into the left ventricle via a patent foramen ovale for biventricular pacing for resynchronization therapy. Later, the patient developed life-threatening pacemaker lead-associated endocarditis with sepsis. Emergency open heart surgery for lead removal was necessary in the form of a reoperation after bypass graft surgery a number of years earlier.
  
  
  CONCLUSIONS
  Although it is technically feasible to implant the pacemaker lead into the left ventricle via a patent foramen ovale, we consider this option to be obsolete for use with a biventricular pacemaker, due to the multitude of risks, which can, in part, be life-threatening for the patient.
authors: Department of Cardiac Surgery, Herzzentrum Leipzig, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. Thomas-Schroeter@gmx.de
authors: T
authors: T
authors: Schroeter
authors: M A
authors: MA
authors: Borger
authors: F W
authors: FW
authors: Mohr
mesh_terms: D000368:Aged; D020878:Device Removal / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004696:Endocarditis / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D054092:Foramen Ovale, Patent / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D019919:Prosthesis Implantation / Q000379:methods; D018805:Sepsis / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery