開心術後の一時的ペーシングワイヤーの上行大動脈内への迷入

Migration of a Temporary Epicardial Pacing Wire into the Aorta Following Open Heart Surgery

開心術後の心外膜ペーシングワイヤー（以下，ワイヤー）迷入は非常にまれな合併症である．いくつかの報告例はある1，2）が，治療戦略およびその対策に関する文献は少ない．本例から学んだことについて報告する．

The patient was a 76-year-old female. An epicardial pacing wire was inserted in an open heart surgery. As there was some resistance when extracting it, it was cut off at the cutaneous level. Ten months after discharge, she was referred to our hospital for further examination due to a flap found in the left external carotid artery by the carotid echography. The remaining wire was found between the ascending aorta and the left external carotid artery by computed tomography （CT）. It was considered that the wire, with no resistance after being cut off, became isolated, pierced the ascending aorta, moved further by the heart beat, and reached the left external carotid artery. Surgery was performed via median re-sternotomy and left common carotid artery incision, since the proximal edge of the wire remained in the mediastinal space. It is quite rare for a remaining pacing wire to migrate into the aorta.