Retained Epicardial Pacing Wires
“A Baby in the Heart”
A 45-year-old man underwent aortic valve replacement 2 years ago. He was currently asymptomatic and maintaining therapeutic international normalized ratio. On routine follow-up transthoracic and transesophageal echocardiography, he was discovered to have a 4.4×5-cm rounded mass with varying echogenicity extending into the right atrium, (Figure 1A and 1B and Movie I in the online-only Data Supplement). There was no pericardial effusion, and a normally functioning St. Jude bileaflet mechanical prosthetic valve was visible. Chest x-ray revealed a rounded paracardiac mass with a metallic nidus simulating the figure of a reclining baby, representing in situ retained epicardial pacing wires (Figure 2, posterior-anterior and lateral views). A 64-slice computed tomography confirmed an organized intrapericardial hematoma around retained pacing wires extending into the right atrial wall (Figure 3, arrow). Microtrauma during epicardial lead removal with slow insidious leak and subsequent formation of organized hematoma around the retained pacing wires could be the mechanism in this case.
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.113.002737/-/DC1.
- © 2013 American Heart Association, Inc.