Figure 4From: Successful management of multiple permanent pacemaker complications – infection, 13 year old silent lead perforation and exteriorisation following failed percutaneous extraction, superior vena cava obstruction, tricuspid valve endocarditis, pulmonary embolism and prosthetic tricuspid valve thrombosis Intraoperative photograph showing the tip of a pacemaker lead lying outside the right atrium, surrounded by inflammatory granuloma and densely adherent to the undersurface of the sternum.Back to article page