December 2023
INTERESTING ECHO OF THE MONTH
Case History
24 yrs-old, known case of congenital CHB – S/P PPI-VVIR (Medtronics). The
first implant was in 2006 (when he was 7 years old); replacement of generator was done in 2013; however there was lead fracture which needed new lead placement in 2014. Last year generator replacement for battery depletion; upgrade to dual chamber was not possible as the subclavian vein was occluded. 6 months prior had pulmonary thrombo-embolism. Reported to have RV clot. (related to the pacing leads); now NYHA II & better. No history of fever. P: 70/min; BP: 110/80 mmHg; O2 sat.:98%.
ECG: V-pace; normal function.
What is the Diagnosis??
Multiple clots attached to pacing lead
The Echo clips in RV inflow view and RV focused view show pacemaker lead seen in RA and RV. There is mobile pedunculated clot in RV apex measuring 1.8 x 0.8 cm (? attached to old lead tip) and one more mobile fresh clot is seen in RA near SVC entrance,? attached to pacing lead, measuring 1.2 x 0.7 cm.