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).