Yeungnam Univ J Med.  2014 Dec;31(2):113-116. 10.12701/yujm.2014.31.2.113.

Implantation of a permanent pacemaker through the coronary sinus in a patient who underwent mechanical valve replacement for infective endocarditis with a complete atrioventricular block

• Jo KH
• Kim I
• Ann SH
• Oh YS

• KMID: 1909818
• DOI: http://doi.org/10.12701/yujm.2014.31.2.113

Abstract

A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

Keyword

Infective endocarditis; Heart block; Artificial cardiac pacemaker; Coronary sinus; Cardiac valve prosthesis

MeSH Terms

Abscess
Ambulatory Care Facilities
Anti-Bacterial Agents
Aortic Valve
Aortic Valve Insufficiency
Atrioventricular Block*
Coronary Sinus*
Debridement
Electrocardiography
Endocarditis*
Fever
Heart Atria
Heart Block
Heart Valve Prosthesis
Humans
Middle Aged
Mitral Valve
Myalgia
Pacemaker, Artificial
Tricuspid Valve
Vital Signs
Anti-Bacterial Agents