Video 1 Transthoracic echocardiogram after lead extraction
Video 2 Three-dimensional evaluation of mass in transthoracic echocardiogram after lead extraction
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Video online
The online version of this article contains two videos. The article and the videos are online available (https://doi.org/10.1007/s12471-022-01754-z). The videos can be found in the article back matter as “Electronic Supplementary Material”.
A 49-year-old man with a history of familial amyloidotic polyneuropathy was admitted to the hospital because of device-related endocarditis. He had undergone a liver transplant and placement of a single-chamber pacemaker 19 years earlier. After transvenous right ventricular lead extraction (LE), transthoracic echocardiography revealed a hyperechogenic, filiform, anomalous mass of 8 × 5 mm (Fig. 1, and see Videos 1 and 2 in Electronic Supplementary Material). The mass was located along the removed lead’s intracardiac route; one end of the mass was attached to the right ventricular wall and the other end was located below the tricuspid valve and had a very mobile tip. An interventional report and an X‑ray confirmed complete LE. The mass was interpreted as a thick, fibrous, tubular encasement of the lead that persisted after extraction, also known as ‘ghost’. A conservative approach was followed. Blood cultures were persistently negative, and the patient remained asymptomatic during subsequent follow-up.
Fig. 1
Transthoracic echocardiography. a Four-chamber right-ventricle focused view showing hyperechogenic, filiform, anomalous mass (8 × 5 mm), with mobile tip curving inside tricuspid valve. b Four-chamber view showing attachments of mass to right ventricular wall and below tricuspid valve
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The presence of ‘ghosts’ is associated with a poor prognosis after LE, but the best approach for patients with this finding remains unclear. To prevent complications such as recurrent infective endocarditis or embolic events, close follow-up is needed [1].
Conflict of interest
V. Neto, J. Santos, N. Craveiro, L. Santos and M. Correia declare that they have no competing interests.
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