Management of a patient with an unusual trajectory of a temporary trans-venous pacing lead

Figure 1 Chest radiography and computed tomography. A: Chest radiography (arrow); B: Computed tomography (arrow) showing that the pacing wire had traversed from the inter-ventricular septum into the left ventricle, and through the left ventricular myocardium to lie within the left pleura.

Figure 2 Transoesophageal echocardiogram on admission demonstrated severe Carpentier IIIB mitral regurgitation from chordal entrapment by the pacing wire (arrow), without pericardial effusion.

Figure 3 Following left anterior thoracotomy in the 6^th intercostal space. A: A Teflon-pledgeted 3-0 polypropylene purse-string suture was tied around the protruding pacing wire at the left ventricular apex; B: Alongside transvenous lead withdrawal.