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

Kapoor, Aditya; Syal, Sanjiv; Gupta, Nirmal Kumar; Gupta, Archana

doi:10.1510/icvts.2010.264853

Cited by 15 publications

(13 citation statements)

References 6 publications

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“…During removal, patients are at risk of ventricular arrhythmias [18] and to a lesser extent bleeding due to injury of nearby structures [19-21]. Also retention of PWs may be complicated by deep seated infections or migration to different structures in the chest [7-9,22,23]. …”

Section: Discussionmentioning

confidence: 99%

Predictors of temporary epicardial pacing wires use after valve surgery

AlWaqfi

Ibrahim

Khader

et al. 2014

J Cardiothorac Surg

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BackgroundAlthough temporary cardiac pacing is infrequently needed, temporary epicardial pacing wires are routinely inserted after valve surgery. As they are associated with infrequent, but life threatening complications, and the decreased need for postoperative pacing in a group of low risk patients; this study aims to identify the predictors of temporary cardiac pacing after valve surgery.MethodsA retrospective analysis of data collected prospectively on 400 consecutive valve surgery patients between May 2002 and December 2012 was performed. Patients were grouped according to avoidance or insertion of temporary pacing wires, and were further subdivided according to temporary cardiac pacing need. Multiple logistic regression was used to determine the predictors of temporary cardiac pacing.Results170 (42.5%) patients did not have insertion of temporary pacing wires and none of them needed temporary pacing. 230 (57.5%) patients had insertion of temporary pacing wires and among these, only 55 (23.9%) required temporary pacing who were compared with the remaining 175 (76.1%) patients in the main analysis. The determinants of temporary cardiac pacing (adjusted odds ratios; 95% confidence interval) were as follows: increased age (1.1; 1.1, 1.3, p = 0.002), New York Heart Association class III- IV (5.6; 1.6, 20.2, p = 0.008) , pulmonary artery pressure ≥ 50 mmHg (22.0; 3.4, 142.7, p = 0.01), digoxin use (8.0; 1.3, 48.8, p = 0.024), multiple valve surgery (13.5; 1.5, 124.0, p = 0.021), aorta cross clamp time ≥ 60 minutes (7.8; 1.6, 37.2, p = 0.010), and valve annulus calcification (7.9; 2.0, 31.7, p = 0.003).ConclusionAlthough limited by sample size, the present results suggest that routine use of temporary epicardial pacing wires after valve surgery is only necessary for high risk patients. Preoperative identification and aggressive management of predictors of temporary cardiac pacing and the possible modulation of intraoperative techniques can decrease the need of temporary cardiac pacing. Prospective randomized controlled studies on a larger number of patients are necessary to draw solid conclusions regarding the selective use of temporary epicardial pacing wires in valve surgery.

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Section: Discussionmentioning

confidence: 99%

Predictors of temporary epicardial pacing wires use after valve surgery

AlWaqfi

Ibrahim

Khader

et al. 2014

J Cardiothorac Surg

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“…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. In 2012, another case of migration occurred where the lead travelled from the right ventricular myocardium into the pulmonary artery in a patient who had successfully undergone CABG 13 years prior 17.…”

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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“…Two patients from the study group had localized pericardial hematoma post Bentall procedure and following CABG operation. Kapoor et al [16] reported a case of delayed complications related to retained epicardial pacing wires left in situ with consequent organized pericardial hematoma around the wires presenting three months following aortic valve replacement surgery especially in patients on long term oral anticoagulants. Also there were seven patients with pericardial effusion.…”

Section: Discussionmentioning

confidence: 99%

“…The graft related surgical complications of coronary arteries include spasm [3], graft thrombosis [4] [5], malposition, kinking [5] [6], and iatrogenic complications such as retained clips, aneurysm and pseudoaneurysm of graft and ascending aorta, ostium stenosis and occlusion of coronary artery after Bentall procedure [6]- [9]. The non-graft related surgical complications include pleural and pericardial effusion [10]- [17], sternal and mediastinal infections [16]- [19], mediastinal hematomas [18] [19], and pulmonary embolism [3]- [20]. Many authors have demonstrated that CT is an invaluable tool in the assessment of post-operative complications after CABG as it is accurate, reproducible, short time, but with a diagnostic level of radiation dose to the patient [1]- [9].…”

Section: Introductionmentioning

confidence: 99%

A Pictorial Review on the Role of 64-Slice HD MDCT in Detecting Post CABG Cardiothoracic Complications

Helmy¹,

Asbeutah²,

Elfiki³

et al. 2014

OJTS

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Aims: The aim of this study is to have a pictorial review on the role of 64-slice multi-detector computerized tomography (MDCT) in detecting post coronary artery graft (GABG) cardiothoracic complications. Materials & Methods: During the period from November 2012 to December 2013, a prospective evaluation of 40 patients with suspected post-operative cardiothoracic complications underwent MDCT coronary angiography in our clinical radiology department. Informed consent was obtained from all patients and the study had institutional review board approval. Descriptive statistics were used to analyze the data. Results: There were 35 males and 5 females, their mean age ± (SD) of 57 ± 3.9 years. A total of 60 grafts were available for evaluation. Two patients could not be evaluated due to clip-artifacts and advanced atherosclerotic disease. Eleven patients showed occluded graft (9) at proximal and distal (2) anastomosis. Seven patients showed pericardial effusion and pleural effusion (8). Two patients had chest wall infection with retrosternal extension and associated mediastinal involvement. One patient showed aneurysm at the re-implanted coronary artery after Bentall procedure, another patient had postoperative myocardial infarction, one patient showed dissection of the ascending aorta, one patient pseudoaneurysm of left ventricle, two patients localized pericardial hematoma, two patients pulmonary embolism, and two patients showed pneumonia. All these complications occurred from 1 -60 days from surgery. Conclusion: HD MDCT is an easy non-invasive technique which showed to be effective in diagnosis of most postoperative CABG cardiothoracic complications and is gaining more ground in difficult clinical situations. Keywords

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

Cited by 15 publications

References 6 publications

Predictors of temporary epicardial pacing wires use after valve surgery

Predictors of temporary epicardial pacing wires use after valve surgery

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

A Pictorial Review on the Role of 64-Slice HD MDCT in Detecting Post CABG Cardiothoracic Complications

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