Removal of abandoned wire leads from a cardiac device: untying or extracting the Gordian knot

Abstract

Wire leads are considered the weakest link of intracardiac devices. The removal of those which were chronically implanted is always a difficult procedure. Such procedure is performed with a near to 100% effectiveness in centers having devices for percutaneous extraction, but when there is no such technology, surgery –minor one or open heart with extracorporeal circulation– is often performed by the cardiovascular surgeon, who has to assume the leading role because of the risk of injury to cardiac structures. A patient with abandoned pacemaker leads is presented. The passage of the wire leads through the subaponeurotic space of the right hemithorax produced discomfort for years, and certain deformities of the chest wall, without the chance of being withdrawn in spite of multiple attempts. The particularities of this case outline the importance of not underestimating these kinds of surgeries, and performing adequate preoperative studies that allow the properly planning of surgical procedure.