6. Discussion
Transesophageal echocardiography is a very important part of patient evaluation before transvenous lead extraction because of its ability to detect phenomena related to the presence of leads in the heart and potentially affecting the course, safety and efficacy of the procedure [1,2]. In this study the echocardiographic findings in patients with CIEDs were divided into four basic groups: 1.tricuspid valve dysfunction 2. presence of any shadows on the leads before TLE 3. presence of excess lead loops in the heart and 4. perforation or penetration of the lead through the cardiac wall up to the epicardium. From the viewpoint of the planned transvenous lead extraction, the most important findings were the many faces of fibrosis associated with the leads varying in location and intensity. The degree of resistance/hardness and fibrosis - the most common enemy of the operator - appeared to determine the level of difficulty and safety of the procedure. There is a large volume of published studies describing the presence of mobile masses attached to the leads visualized by TTE, TEE and ICE in asymptomatic patients [22-23]. In this study additional masses on endocardial leads (AMEL) were defined as fibrous connective tissue
(accretions), clots, vegetations-like massess. Similar to Golzio PG et al. [23], we also took into consideration lead thickening and hyperechogenicity, frequently present (29.594%) in patients undergoing TLE (Figure 1).