Right ventricular laceration caused by sternal wire fracture following cardiac surgery: a case report

Sternal dehiscence and sternal wire fractures are of significant concern for patients post cardiac surgery. Right ventricular laceration resulting from injury secondary to fractured sternal wires is a rare cause of life-threatening postoperative hemorrhage. A 68-year-old male presented for coronary artery bypass grafting (CABG). Postoperatively, he experienced an exacerbation of chronic obstructive pulmonary disease (COPD) which initially responded to medical treatment. While mobilizing, the patient experienced acute hemodynamic decompensation. Chest X-ray revealed a new left pleural effusion and a bedside echocardiogram revealed significant pericardial effusion. The patient was taken urgently for re-exploration with a diagnosis of cardiac tamponade. All sternal wires were found to be fractured and a right ventricular laceration was identified. The laceration was repaired primarily with sutures and the sternum was closed with reinforced sternal wires. The patient recovered well postoperatively and was discharged without further complication. Postoperative hemorrhage is a known complication of cardiac surgery but is rarely caused by laceration secondary to sternal wire fracture. Alternative sternal closure techniques should be considered in high-risk groups of patients. A high index of suspicion should be maintained for patients with sternal dehiscence. Furthermore, these patients should be monitored closely and definitive management implemented immediately when sternal wire fracture and resulting injury are suspected.