Intravascular migration of fractured sternal wire presenting with hemoptysis

doi:10.1016/S0003-4975(00)02311-0

The Annals of Thoracic Surgery

Volume 71, Issue 5, May 2001, Pages 1682-1684

https://doi.org/10.1016/S0003-4975(00)02311-0 Get rights and content

Abstract

We present a rare complication of median sternotomy in which a segment of fractured sternal wire punctured the heart, embolized to the right lung, and eroded into a bronchus causing massive hemoptysis. It was safely removed through a median sternotomy. Sternal wire fracture or migration is diagnosed easily on chest roentgenograms, but frequently goes unnoticed. Sternal wire failure can be managed nonoperatively; however, repair is indicated if fractured wires are displaced or potentially migratory.

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Comment

Although generally regarded as an insignificant finding 1, 4, sternal wire fracture may result in serious morbidity and death. Cardiac tamponade and massive hemothorax have been attributed to fractured wires 1, 3 and puncture of the ascending aorta by a migratory segment has been reported as well [2]. In our patient, migration of a fractured wire into the right ventricle allowed embolization to the right middle pulmonary artery resulting in massive hemoptysis as it eroded into an adjacent

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Mokhtar et al. recently reviewed 11 cases of fractured sternal wire migration.1 The injuries associated with this complication were often life-threatening, involving the ascending aorta,2-4 pulmonary artery,1,5 right ventricle,6,7 right mainstem bronchus and its branches,5,8 or bilateral pleura.9 One fatality (9%) was reported among these cases.1,3
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We present a case of a 56-year-old man with history of coronary artery disease and prior two coronary bypass surgeries, who presented with chronic chest pain and was found to have a fractured sternal wire that migrated through the right ventricle and embolized to the right lower pulmonary artery without evident hemodynamic consequences. The sternal wire migration process, in part due to patient's poor medical compliance, was captured on serial computed tomography scans over a period of several years.
<Learning objective: Recognize potential sternotomy complications on imaging. Identify rare but potentially dangerous complications of sternal wire fractures. Review of the literature on sternal wire embolization.>
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Dermatologic surgeons should particularly be aware that temporary epicardial pacing wires and pacemaker leads are not uncommonly abandoned in the chest wall of many patients. All patients with a cardiac surgery history should be questioned about possible retained wires. If wire material is encountered intraoperatively, immediately stop the procedure and do not attempt further manipulation of the wire until suggested steps are taken to ascertain the wire type.
Sternal Talon offers a solution for secondary sternum osteosynthesis in patients with nonunion
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Median sternotomy may be associated with postoperative complications such as nonunion after conventional metal wire closure. The Sternal Talon device (KLS Martin, Jacksonville, FL) has recently been introduced as an alternative for osteosynthesis after median sternotomy and may also be beneficial for patients with persistent sternal nonunion.
A consecutive series of 24 patients underwent Sternal Talon repair for sternal nonunion or acute mediastinitis, or both, after sternal wire closure. Patient data—including demographics, surgical history, and indication for operation, as well as outcomes—were obtained and analyzed by retrospective chart review.
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Case reportIntravascular migration of fractured sternal wire presenting with hemoptysis

Abstract

Section snippets

Comment

Ann Thorac Surg

Am Heart J

J Thorac Cardiovasc Surg

Ann Thorac Surg

Case report
Intravascular migration of fractured sternal wire presenting with hemoptysis