A Case of Septic Pulmonary Embolization due to Pacemaker Infection in Which Long-Term Perioperative Ventilation Was Required

(Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan)

Takashi Yoshinaga Ryuji Kunitomo Shuji Moriyama
Kentaro Takaji Yayoi Takamoto Hidetaka Murata
Michio Kawasuji
Septic pulmonary embolization(SPE)is an uncommon pulmonary disorder. The diagnosis of SPE is frequently delayed because of its nonspecific chest roentgenological features. A 76-year-old woman who underwent pacemaker implantation one year previously received antibiotic therapy under a diagnosis of infectious colitis. She suffered septic shock and disseminated intravascular coagulation(DIC)and was admitted to our hospital. Methicillin-resistant Staphylococcus aureus(MRSA)was cultured from her blood and echocardiography demonstrated 13×16mm vegetation originating from the tricuspid valve. Multiple peripheral nodules with cavitation were found on chest computed tomography and she was given a diagnosis of SPE. She rapidly presented acute respiratory failure and mechanical ventilation was inevitable for 23 days before surgery. She underwent removal of the entire pacing system, resection and repair of the tricuspid valve and epicardial pacemaker lead implantation. Tracheostomy and long-term mechanical ventilation(16 days)was required after surgery, however, she was discharged from our hospital without any complication.
  Jpn. J. Cardiovasc. Surg. 38:262-265(2009)