A rare entity - percutaneous lead extraction in a very late onset pacemaker endocarditis - case report and review of literature

Video 1. Transthoracic two-dimensional echocardiography apical 4-chamber view: large hypoechogenic hyper-pedunculated mobile mass at the level of tricuspid valve; Video 2. Transesophageal two-dimensional echocardiography: low echogenicity pedunculated mass attached to the pacemaker lead, with multiple sites of binding, with no supplementary involvement of the tricuspid valve and myxomatous appearance of the posterior leaflet with hypermobility and rupture of chordae; Video 3. Fluoroscopy during the lead extraction procedure, after freeing the lead from adhesions: traction of the lead from the right ventricular apex, through the tricuspid valve, right atrium, superior vena cava and left subclavian vein, to complete lead removal; Video 4. Postprocedural transesophageal two-dimensional echocardiography: posterior leaflet chordae rupture, no residual vegetation, no pericardial effusion; Video 5. Transthoracic two-dimensional echocardiography parasternal short axis, no additional cardiac masses, posterior leaflet chordae rupture of the tricuspid valve; Video 6. Transthoracic two-dimensional echocardiography parasternal short axis, color Doppler: mild tricuspid regurgitation, with two small thin jets.