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We report on a 51-year old heart transplant recipient in whom a pacing lead fragment of his old implantable cardioverter-defibrillator (ICD) had been detected in the left ventricle following successful heart transplantation. The patient was transplanted after 5 weeks on high urgent status. A postoperative routine chest X-ray and a subsequent cardiac three-dimensional (3D) computed tomography scan showed a metallic foreign body bending during systole below the posterior mitral valve leaflet within the left ventricle of the heart transplant. Transarterial extraction therapy was planned and the femoral artery was cannulated in the usual fashion. An 8F snare catheter was directed into the left ventricle under fluoroscopic guidance. Successful extraction revealed a 3-cm, uncoated ICD fragment (diameter = 0.025 in.). Following extraction of the fragment echocardiography showed mild mitral regurgitation but no further adverse events occurred. The patient was discharged 2 days later. Transarterial fragment extraction using a snare catheter is a feasible, minimally invasive procedure in this clinical scenario. Careful inspection of all explanted hardware is strongly recommended to ensure that no portion of an ICD lead is left behind.

interactive cardiovascular and thoracic surgery

Three-dimensional computed tomography imaging of an implantable cardioverter-defibrillator lead fragment in the left ventricle of a heart transplant followed by successful transarterial extraction with a snare catheter†