Symptomatic pulmonary embolism in infectious endocarditis associated with permanent implantable electrical devices undergoing percutaneous extraction
Keywords:
artificial pacemaker, bacterial endocarditis, catheter-related infections, implantable cardioverter-defibrillators, pulmonary embolismAbstract
Introduction: Infective endocarditis (IE) associated with permanent implantable electronic devices (PIED) is a complication of low frequency. Progress on the knowledge of this disease and the development of therapeutic strategies such as early diagnosis, antibiotic management and better extraction techniques, among others; have improved the prognosis of these patients. One of the most feared complications is pulmonary embolism. In this paper we will make a general review of the subject and present our case series focused on patients with IE associated with PIED undergoing percutaneous extraction complicated by symptomatic pulmonary embolism (PE).
Objectives: To determine the incidence and morbidity and mortality of patients with infective endocarditis associated with PED undergoing percutaneous extraction who presented symptomatic PE.
Methodology: This study was conducted as a cross-sectional, descriptive study, ambispectively including patients diagnosed with IE associated with PED undergoing percutaneous extraction with signs and symptoms suggestive of PE. The study population consisted of patients admitted to the ex-Hospital of the UAI University - Santa Barbara Sanatory in Buenos Aires, Argentine. Statistical analysis of the data was performed using Microsoft Excel 2016.
Results: 97 patients with IE associated with PIED were identified; 9 presented symptomatic PE (9,3%). Baseline, diagnostic, therapeutic, and in-hospital outcomes were analyzed. In this group, S. aureus was the most common pathogen, with vegetations larger than 15 mm, pedunculated, and moderately mobile. All patients received antibiotics for six weeks and had their system completely removed percutaneously. Mortality was nil. The mean hospital stay was 41 weeks (38-44). Only one patient presented a hospital complication (Atrial fibrillation).
Conclusions: There was a 9.3% rate of symptomatic PE in patients with IE associated with PED undergoing percutaneous extraction, however, morbidity and mortality were not influenced.
