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Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation
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The catastrophic journey of a retained temporary epicardial pacemaker wire leading to Enterococcus faecalis

Harleen Kaur Dyal1, Rohit Sehgal2

  • 1Royal College of Surgeons in Ireland, Dublin 2, Ireland.

BMJ Case Reports
|January 9, 2015
PubMed

Insights

A migrated temporary epicardial pacemaker wire (TEPW) after coronary artery bypass graft (CABG) surgery led to aortic valve endocarditis and stroke. Prompt management included antibiotics, wire removal, and valve replacement.

Area of Science:

  • Cardiology
  • Infectious Disease
  • Neurosurgery

Background:

  • Coronary artery bypass graft (CABG) surgery is a common procedure for coronary artery disease.
  • Temporary epicardial pacemaker wires (TEPW) are often used post-CABG for cardiac rhythm management.
  • Complications from retained surgical materials can be serious and delayed.

Observation:

  • A 52-year-old male presented with stroke symptoms three months after CABG.
  • Imaging revealed a migrated TEPW perforating the right atrial appendage into the ascending aorta.
  • Vegetations were found on the migrated TEPW and the aortic valve.

Findings:

  • The patient was diagnosed with Enterococcus spp. aortic valve endocarditis and aortic regurgitation.
  • The migrated TEPW was identified as the likely source of bacterial seeding.
  • The endocarditis and TEPW migration contributed to the patient's ischemic stroke.

Implications:

  • Retained TEPW pose a significant risk for delayed endocarditis and embolic events.
  • Early recognition and management of migrated TEPW are crucial.
  • This case highlights the importance of meticulous surgical material management post-CABG.

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