Video-assisted endoscopic removal of infected endocardial pacemaker lead with large floating vegetation

The best management of pacemaker lead related endocarditis is complete surg ical or percutaneous removal of the pacemaker syst em. Although the traditi onal surgical approach is via median sternotomy, we present two cases in wh ich the lead and vegetations Mere removed using a video-assisted endoscopic technique through a limited right submammary incision. in each case the pa tient was supported by partial extracorporeal perfusion. Additional tricusp id valve repair and atrial septal defect closure was performed in one case. The postoperative courses were uneventful, illustrating that, when compare d to the conventional open heart surgical approach, the less invasive appro ach can be a safe and effective way to remove an infected foreign body from the right heart with increased comfort, fast recovery, and a better cosmet ic result.