Late intrathoracic migration of a retained temporary epicardial pacing wire associated with middle lobe atelectasis and hemoptysis 15 years after aortic valve replacement: a case report

BACKGROUND: Temporary epicardial pacing wires (TEPWs) are routinely placed after cardiac surgery for temporary rhythm management and are typically removed within a few days. Although retained wires are uncommon, late migration may lead to serious complications. CASE PRESENTATION: An 80-year-old man who had undergone aortic valve replacement 15 years earlier was referred for evaluation of right middle lobe atelectasis detected on computed tomography (CT). Bronchoscopy revealed mucus obstruction and distal mucosal edema of the right middle lobe bronchus. The patient subsequently developed hemoptysis. Contrast-enhanced CT demonstrated a continuous 11-cm linear high-density structure extending from the right hilum to the inferior cardiac surface, near the middle lobe bronchovascular structures. Intrathoracic migration of a retained TEPW was suspected, and surgical removal was performed. Thoracoscopic exploration revealed dense hilar adhesions; therefore, the pericardium was opened through the same thoracoscopic ports, and the wire was removed using an intrapericardial approach. The postoperative course was uneventful. CONCLUSIONS: Retained TEPWs may migrate intrathoracically even many years after cardiac surgery. In the present case, the migrated wire was anatomically adjacent to the middle lobe bronchovascular structures and was clinically associated with atelectasis and hemoptysis, although direct bronchial penetration was not confirmed. In selected cases with hilar or pericardial-adjacent migration, an intrapericardial approach may facilitate safe removal.