title: Aortic bleeding one week after removal of an intraoperative epicardial temporary pacing wire.
abstract: A 56-year-old man had left nephrectomy and resection of a cavoatrial tumor thrombus under a cardiopulmonary bypass assist for left renal cell carcinoma. An intraoperative bipolar temporary epicardial atrial pacing wire was removed on postoperative day 8. The patient collapsed on postoperative day 15. Emergent transthoracic echocardiography and computed tomography scanning with contrast media detected cardiac tamponade. The three-dimensional volume-rendering images from the multislice computed tomography scan demonstrated bleeding from the aortic root. Upon emergency operation, active arterial bleeding from the aortic root distal to the sites of cannulation and cardioplegia was confirmed, and hemostasis with sutures was completed. It is well known that the intraoperative temporary epicardial pacing wire can cause bleeding or arrhythmia, especially when the wire is being removed. However, bleeding usually occurs from the inserted epicardial point of the pacing wire soon after removal of the wire. To our knowledge, this late bleeding complication of the pacing wire is a previously unreported serious iatrogenic complication after cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, Maizuru Mutual Hospital, Maizuru, Kyoto, Japan. atmatsu@tokyonet.com.au
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Matsushita
authors.forename: Haruki
authors.initials: H
authors.lastname: Fuse
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Masuda
authors.forename: Tomoya
authors.initials: T
authors.lastname: Inoue
mesh_terms: D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D002305:Cardiac Tamponade / Q000209:etiology; D020878:Device Removal / Q000009:adverse effects*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012086:Reoperation; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery