Janík Martin, Hejna Petr, Straka Ľubomír, Krajčovič Jozef, Novomeský František
Institute of Forensic Medicine and Medicolegal Expertises, Jessenius Faculty of Medicine, Comenius University, University Hospital, Martin, Slovak Republic.
Department of Forensic Medicine, Faculty of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic.
Leg Med (Tokyo). 2018 May;32:107-112. doi: 10.1016/j.legalmed.2018.04.001. Epub 2018 Apr 5.
Strangulation of the heart appears to be an exceedingly rare mechanical phenomenon that can develop with epicardial pacing wires in individuals undergoing somatic growth. Over the passage of time, owing to size mismatch between a fixed wire length and dynamically growing heart, the epicardial wire may embed around the heart resulting in the progressive over-pressurizing of involved cardiac structures. Depending on the location of the peak constriction pressures, cardiac strangulation may damagingly affect coronary circulation, heart valves function, or physiologic filling of the heart chambers, with risk of myocardial ischemia, decreased cardiac output, acute cardiac failure, ventricular arrhythmias and death. We report a case of a 29-year-old male with sudden cardiac death owing to cardiac strangulation with epicardial pacing wire that had been retained in place almost 30 years. At autopsy, an enlarged and abnormally contoured heart was found to be strangulated by an epicardial pacing wire; histopathologic examination confirmed hypertrophy of the myocardial fibers, myofiber disarrangement, and replacement-type fibrolipomatosis. In addition, this article consolidates the available literature on cardiac strangulation by an epicardial wire and highlight relevant clinical and medico-legal features for the forensic professionals.
