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Endocardium of right atrium definition: Endocardium of atrium which is continuous with the tunica intima of the superior and inferior vena cavae.
 
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We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

Transesophageal echocardiogram revealed extensive and complex vegetation surrounding all leads in SVC, RA, RV and also involving tricuspid valve and right atrial and right ventricular endocardium (fig 3 ).

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

Presence of huge vegetations along the entire tract of the leads including right atrial and right ventricular endocardium and the tricuspid valve as well as the entangling of the tricuspid valve chordae with the RV leads mandated excision and replacement of tricuspid valve with a prosthetic valve.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

Presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in SVC, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction 3.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

 
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