Enhancing Surgical Decision-Making for Infected Cardiac Device Lead Removal With 18F-FDG PET/CT - Case Study and Literature Analysis

Sep 28, 2026

Uploaded by Ben

Residual implantable cardiac electronic device leads increase infection risk and require a multimodal diagnostic and therapeutic plan. This case emphasizes how PET/CT imaging supports surgical decisions, especially for chronic infections with embedded or fractured lead fragments. Percutaneous extraction may be incomplete, making cardiopulmonary bypass surgery necessary for definitive management. Early recognition of residual infected material helps prevent recurrent sepsis and improves patient outcomes through coordinated imaging, targeted antimicrobial therapy, and surgical expertise.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Introduction

Case History/Examination

Investigations and Treatment

Clinical Case Reports CASE REPORT OPEN ACCESS Enhancing Surgical Decision-Making for Infected Cardiac Device Lead Removal With 18F-FDG PET/CT: A Case Study and Literature Analysis Said Khallikane1 | Reda Mounir2,3 | Noureddine Atmani4,5 | Abdessamad Abdou4 | Ayoub Belhadj6 | Younes Aissaoui6 1Anesthesia-Intensive Medicine, Cardiothoracic Anesthesiologist Cardiothoracic Anesthesia-Cardiovascular ICU, Anesthesiology-ICU-Emergency Department Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco | 2Cardiothoracic and Vascular Surgeon, Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco | 3Faculty of Medicine and Pharmacy of Rabat 10000, Mohammed V University, Rabat, Morocco | 4Mini-Invasive Cardiac Surgery, Interventional Cardiovascular Surgery, Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco | 5Faculty of Medicine and Pharmacy ofFes, Sidi Mohamed Beni Abdellah University, Morocco | 6Avicenna Military Hospital, Surgical ICU, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco Correspondence: Said Khallikane ([saidkhallikane85@gmail.com](saidkhallikane85@gmail.com)) Received: 29 January 2025 | Revised: 28 September 2025 | Accepted: 9 November 2025 Keywords: cardiac device-related infection | cardiac surgery | fluoroscopy guidance | implantable cardiac electronic device | multimodal diagnostic approach | PECT-scanner ABSTRACT Residual implantable cardiac electronic device (ICED) leads pose a significant infection risk, necessitating a multimodal diagnostic and therapeutic approach. This case highlights the critical role of PET/CT imaging in guiding surgical decision-making, particularly in cases of chronic infections with embedded or fractured lead fragments. While percutaneous extraction may be incomplete, surgical intervention under cardiopulmonary bypass is often required for definitive management. Early identification of residual infected material is essential to prevent recurrent sepsis and optimize patient outcomes. A comprehensive strategy integrating advanced imaging, targeted antimicrobial therapy, and surgical expertise is key to successfully managing complex ICED-related infections. 1 | Introduction ICED-related infections are increasing, with Staphylococcus aureus as the leading pathogen. While complete transvenous lead extraction with targeted antibiotics is standard therapy, surgical removal under CPB is required when extraction fails or leads are inaccessible. We report a 64-year-old man with esophageal achalasia and along-standing ICD who developed MRSA infective endocarditis after device replacement. Despite initial transvenous and surgical extraction, residual infected fragments caused recurrent sepsis and sternal wound dehiscence. In November 2024, 18F-FDG PET/CT identified persistent infection, prompting successful reoperation using fluoroscopic guidance due to contraindication to TEE. This case illustrates the essential role of PET/CT in detecting residual intracardiac infection when conventional imaging is limited, and demonstrates the value of a multimodal strategy combining advanced imaging, targeted antimicrobials, and precise surgical intervention. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. Clinical Case Reports, 2026; 14:e71781 1 of 9 [https://doi.org/10.1002/ccr3.71781](https://doi.org/10.1002/ccr3.71781) Key Clinical Message This case highlights the unique value of 18F-FDG PET/ CT in identifying deeply embedded, chronically infected ICD lead fragments when conventional

FAQs

Why are residual infected cardiac device leads clinically significant?

Residual implantable cardiac electronic device leads carry a high infection risk and can contribute to persistent or recurrent infection. The document highlights the need for early detection to prevent recurrent sepsis.

What role does 18F-FDG PET/CT play in surgical decision-making?

18F-FDG PET/CT helps identify deeply embedded, chronically infected lead fragments when conventional imaging is inconclusive or when TEE is contraindicated. It supports choosing definitive reoperation under cardiopulmonary bypass.

When is surgical removal under CPB preferred over percutaneous extraction?

Surgical intervention is required when percutaneous extraction is incomplete, fails (e.g., laser-assisted removal does not succeed), or when leads are inaccessible. The case describes reoperation after persistent infection and recurrent complications.

Sep 28, 2026

Uploaded by Ben