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Right Ventricular Perforation by Fractured Sternal Wires: A Narrative Review
Carlos Gallego-Navarro1, Omar Latif2, Sorin V Pislaru3
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, United States of America.
Fragmented sternal wires migrating to the right ventricle are rare after cardiovascular surgery. Early diagnosis and individualized treatment are crucial for managing this complication, which can present with severe symptoms or be asymptomatic.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Fragmented sternal wire migration is a rare complication post-cardiovascular surgery.
- Presentation varies from incidental findings to hemodynamic instability.
- This study describes two cases of wire migration to the right ventricle.
Purpose of the Study:
- To describe two cases of fragmented sternal wire migration to the right ventricle.
- To review the literature on similar cases.
- To compare clinical variables and discuss diagnostic and management strategies.
Main Methods:
- Retrospective review of two patients with sternal wire migration.
- Literature review of 11 additional cases.
- Comparison of clinical data, diagnostic imaging, and management outcomes.
Main Results:
- A total of 13 patients (85% male, median age 64) were analyzed.
- Presentations included hemorrhagic shock (46%), cardiovascular symptoms (46%), or asymptomatic (8%).
- Sternal dehiscence was common (61%); presentation was bimodal (early vs. late post-sternotomy).
Conclusions:
- Sternal wire migration occurs in the context of sternal dehiscence/instability, days to years after sternotomy.
- Cardiac injury associated with migration can be subtle and missed on CT scans.
- Individualized treatment based on patient needs is recommended after diagnosis.
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