Figure 3. Chest CT without contrast in the coronal (left) and
axial (right) plane. Despite no remark on it, the pacemaker lead is seen
crossing into the left ventricle (arrows).
A week later, the pacemaker pocket was found to be infected with
Klebsiella organism. The decision was made to remove the pacemaker
generator. A transesophageal echo (TEE) was subsequently performed in
preparation for removal of the long-neglected leads. Imaging showed the
ventricular pacemaker lead crossing through a patent foramen ovale into
the left atrium, through the mitral valve, and inserted into the lateral
wall of the left ventricle (Figure 4). The TEE detected no vegetation
but showed the ventricular lead interfering with coaptation of the
mitral valve leading to at least moderate mitral valve regurgitation
(Figures 5 and 6).