Pacemaker-related endocarditis: the value of transoesophageal echocardiography in diagnosis and treatment.

We report 5 cases with pacemaker endocarditis. All cases were presented with long-standing fever and the diagnosis was confirmed by transoesophageal echocardiography. Besides the contribution to diagnosis, transoesophageal echocardiography defined the technique that was applied to remove the pacing system. In four patients with large vegetations (> 10 mm) the entire pacing system was removed by thoracotomy, while in one with relatively small vegetations (< or = 10 mm) the pacing system was removed by external traction. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to the role of transoesophageal echocardiography in the early diagnosis and determination of optimal treatment.