Bioprosthetic valve thrombosis and related embolism are considered extremely unlikely, thus allowing most patients to avoid long-term anticoagulation. There is, however, limited experience in the diagnosis and treatment of such a condition. We present the

A 57-year-old man who had received an automatic implantable cardioverter defibrillator and subsequent orthotopic heart transplant presented to medical attention for hemoptysis. The hemoptysis was caused by the migration of the left ventricular patch of the automatic implantable cardioverter defibrillator, which had been left in place at the time of orthotopic heart transplant. The patch had eroded into the left lung. We recommend that implantable cardioverter defibrillators be removed completely at the time of heart transplantation to prevent subsequent complications.