Bilateral sternobronchial fistula after coronary surgery – are the retained epicardial pacing wires responsible? a case report

Sakellaridis, Timothy; Argiriou, Mihalis; Panagiotakopoulos, Victor; Charitos, Christos

doi:10.1186/1749-8090-4-26

Cited by 12 publications

(12 citation statements)

References 10 publications

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“…Reported complications are rare and include bleeding, vascular perforation, atrial or ventricular laceration during wire removal with tamponade, avulsion/laceration of Case Report saphenous vein graft, infection, sternobronchial fistula and even cardiac strangulation by wire ensnarement during removal of wires [1][2][3][4]. Retained pacing wires may rarely also migrate and trans-bronchial, lung, pelvic and transepidermal migration of pacing wires has also been reported [5][6][7].…”

Section: Discussionmentioning

confidence: 96%

Right paracardiac mass due to organized pericardial hematoma around retained epicardial pacing wires following aortic valve replacement

Kapoor

Syal

Gupta

et al. 2011

Interact CardioVasc Thorac Surg

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The use of temporary epicardial pacing wires during cardiac surgery is a routine procedure and has been associated with low morbidity. We describe a rare case of right paracardiac mass due to organized pericardial hematoma with right atrial compression around the epicardial pacing wires left in-situ, presenting three months following aortic valve replacement surgery. The case highlights the fact that such delayed complications can rarely occur around retained epicardial pacing wires following open heart surgery especially in patients on oral anticoagulants. The clinician should be alert to such an occurrence and during follow-up echocardiography always pay attention not only to the valve and ventricular function, but also to the pericardial and extra-pericardial space.

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Section: Discussionmentioning

confidence: 96%

Right paracardiac mass due to organized pericardial hematoma around retained epicardial pacing wires following aortic valve replacement

Kapoor

Syal

Gupta

et al. 2011

Interact CardioVasc Thorac Surg

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“…The second report involved a pacing wire that migrated via the left atrium and left ventricle into the right carotid artery causing an infective endocarditis of the mitral and aortic valve 13. An article published in 2008 queried the use of TEPWs;14 in 2009, another article questioned whether retained pacing wires were the culprit for the development of a sternobronchial fistula that arose in a patient following coronary surgery 15. In 2011, a patient suffered from the development of a right paracardiac mass due to an organised haematoma around retained epicardial pacing wires following aortic valve replacement 16.…”

Section: Discussionmentioning

confidence: 99%

The catastrophic journey of a retained temporary epicardial pacemaker wire leading toEnterococcus faecalisendocarditis and subsequent stroke

Dyal

Sehgal

2015

BMJ Case Reports

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SUMMARYA 52-year-old man underwent triple coronary artery bypass graft (CABG). Three months later, he presented to the emergency room with dizziness and left-sided weakness. Workup revealed right frontal parenchymal haemorrhage; also, two retained temporary epicardial pacemaker wires (TEPW) from his previous CABG were observed, one of which had significantly migrated. One wire was found in the soft tissues below the heart; the other transversed the mediastinum from the expected location of the right atrium, perforating the right atrial appendage, entering the lumen of the ascending aorta and coursing into the mid-descending aorta. There were vegetations (Enterococcus spp) on the migrated TEPW and aortic valve, aortic valve endocarditis and aortic regurgitation. In summary, we suspect the migrated TEPW may be the source of bacteria that seeded the aortic valve, causing endocarditis and contributing to the patient's subsequent stroke. Management involved two 6-week antibiotic courses, wire-extraction, aortic valve replacement and redo CABG. BACKGROUND

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“…[ 3 4 ] On the other hand, infections of sternal wounds account for some of the most serious complications postoperatively for mediastinal sternotomies. [ 5 ] They give morbidity rates at an incidence of 0.4–5%, and mortality rates within the hospital reach 7–29%, even after the correct treatment of mediastinitis is accounted for. [ 5 ] Taking into account the aforementioned, although retained pacing wires are part of a routine procedure, which is well tolerated, it is important to note that complications do occur and they need to be considered when they are left in situ .…”

Section: Introductionmentioning

confidence: 99%

The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review

et al. 2016

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Temporary epicardial pacing wires during open-heart surgery are routinely used both for diagnostic and treatment purposes. In complicated cases where patients are unstable or the wires are difficult to remove, the pacing wires are cut at the skin level and allowed to retract by themselves. This procedure rarely causes complications. However, there have been cases reporting that retained pacing wires are linked to the formation of sterno-bronchial fistulae, which may present a while after the date of operation and are usually infected. This review aims to study the cases presenting sterno-bronchial fistulae due to retained epicardial pacing wires and to highlight the important factors associated with these. It is important to note these complications, as fistulae may cause a variety of problems to the patient if undiagnosed and left untreated. With the aid of scans such as fistulography, fistulae can be identified and treated and will improve the patients’ health dramatically.

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Bilateral sternobronchial fistula after coronary surgery – are the retained epicardial pacing wires responsible? a case report

Abstract: Background: Temporary epicardial pacing wires are routinely used during cardiac surgery; they are dependable in controlling postoperative arrhythmias and are associated with low morbitity.

Cited by 12 publications

References 10 publications

Right paracardiac mass due to organized pericardial hematoma around retained epicardial pacing wires following aortic valve replacement

Right paracardiac mass due to organized pericardial hematoma around retained epicardial pacing wires following aortic valve replacement

The catastrophic journey of a retained temporary epicardial pacemaker wire leading toEnterococcus faecalisendocarditis and subsequent stroke

The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review

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