Replies

• Nice case and excellent discussion of the approach to management of CIEDs and leads for patients needing radiation therapy.  Most often, we don't see significant performance issues for CIEDs after XRT.
  February 15, 2023

• Interesting case!  Of course, one has to consider all of the clinical factors, but assuming the patient is not very frail, I would favor open surgical extraction.  The surgeons will be able to debride this very large vegetation.  They may find the cardiac involvement greater than what is seen on the TOE.  Our experience is that even TOE underestimates actual infectious involvement of the cardiac structures.  I'd be concerned about Option 1, TLE, as embolization of this very large vegetation into the PA may result in hemodynamic collapse acutely.  Additionally, the patient would be left with this large burden of infected tissue which may make him or her more prone to SIRS or persistent bacteremia.   Just my thoughts.  Thanks for sharing the case!
  December 5, 2022