A Foreign Body in the Heart Due to an Unusual Injury

doi:10.1016/j.athoracsur.2009.01.059

The Annals of Thoracic Surgery

Volume 88, Issue 3, September 2009, Pages 985-987

https://doi.org/10.1016/j.athoracsur.2009.01.059 Get rights and content

Penetrating heart injuries are immediate life-threatening situations. We present a case report of a 44-year-old man with a foreign body in his right heart. The injury happened while the man was working with a circular saw 15 months prior to the actual diagnosis. With respect to the size of the foreign body, its close proximity to the right coronary artery, the potential risk of bleeding, embolization, endocarditis or pericarditis, surgical therapy was indicated in spite of the fact that the patient was asymptomatic. The foreign body (a spring-segment of a roller blind) was successfully removed.

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Comment

It is extremely rare to suffer an open injury to the heart and experience no severe symptoms.

The injury previously discussed could be explained as follows: by absorbing kinetic energy (given off by the surface speed of the circular saw), the spring segment acts as a projectile. It is likely that the wire penetrated the right atrial wall longitudinally through the small puncture hole. Because of the elasticity of the right atrial wall, there was no bleeding into the pericardial cavity and thus

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There are more references available in the full text version of this article.

Cited by (11)

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Citation Excerpt :
Symptoms attributable to these foreign bodies, including cardiac tamponade and arrhythmia, are considered a primary indication for removal [37,38]. Simple extraction of the offending object does however pose further risks of damage to a potentially unstable patient (e.g. a missile that approximates a coronary artery or is deeply embedded within the myocardium and tamponading the wound) [39,40]. Furthermore, manipulation of foreign bodies contained within the left heart require great care and speed due to the high risk of critical embolization [41].
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Citation Excerpt :
However, the small and clean objects located in the periphery are well tolerated and can be left behind [1]. The foreign body, lying in proximity to the right coronary artery bears the potential risk of bleeding, embolization, endocarditis or pericarditis, surgical therapy is indicated in such patients in spite of the fact that patient is asymptomatic [4]. We planned to explore our patient, because of presence of sharp object and its proximity to superior vena cava.
Presence of foreign body in thoracic cavity is very uncommon. Most common etiologies for the presence of such foreign bodies are accidental, traumatic or iatrogenic. We report the management of a case with a rare foreign body in the thorax i.e. surgical blade. While inserting ICD the surgical blade slipped from the scalpel and was sucked into the pleural cavity. FB migrated in the mediastinum and Contrast Tomographic scan showed elongated radio-opaque object of metallic density in the mediastinum, just abutting the superior vena cava. An immediate open thoracotomy was planned to retrieve the blade.
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Penetrating cardiac injuries require rapid diagnosis, efficient exposure and nuanced technical approaches, within a framework of highly coordinated and integrated multidisciplinary care. Acute care surgeons, with both strategic and technical expertise, are ideally positioned to address the potentially devastating consequences of these injuries. The aim of this narrative review is to offer a technical approach to the rapid evaluation, exposure, operative repair and postoperative care of penetrating cardiac injuries. A comprehensive review of the cardiac trauma literature, dating back to 1970, has provided a detailed toolbox of approaches to subxiphoid pericardial windows, resuscitative thoracotomy, median sternotomy, pericardiotomy, aortic clamping, cardiac hemorrhage control, cardiac repair, coronary artery injuries, pericardial closure, drain placement, chest wall closures, damage control thoracic procedures and immediate postoperative cardiac care, all based on fundamental physiological principles and anatomical considerations.
Les blessures cardiaques pénétrantes exigent un diagnostic rapide, une exposition efficace du coeur et des approches techniques nuancées, au sein d’un cadre de soins multidisciplinaires hautement coordonnés et intégrés. Les chirurgiens en soins actifs, possédant à la fois une expertise stratégique et technique, sont dans une position idéale pour prendre en charge les conséquences potentiellement dévastatrices de ces blessures. L’objet de cette synthèse narrative est de présenter une approche technique à l’évaluation rapide, à l’exposition du coeur, à la réparation opératoire et aux soins postopératoires des blessures cardiaques pénétrantes. Un examen exhaustif de la documentation portant sur les traumatismes cardiaques, remontant à 1970, a fourni une panoplie de techniques en matière de fenêtres péricardiques par approche sous-xiphoïdienne, de thoracotomie de réanimation, de sternotomie médiane, de péricardotomie, de clampage aortique, de contrôle d’hémorragie cardiaque, de réparation des lésions cardiaques, de traitement des lésions des artères coronaires, de fermeture péricardique, de pose de drains, de fermeture de la paroi thoracique, d’interventions thoraciques de sauvegarde et des soins cardiaques postopératoires immédiats, tous fondés sur des principes physiologiques fondamentaux et des considérations anatomiques.
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Case reportA Foreign Body in the Heart Due to an Unusual Injury

Section snippets

Comment

Ann Thorac Surgery

Ann Thorac Surg

Ann Thorac Surg

Successful salvage of post-traumatic metallic foreign body partially retained in the posterior papillary muscle of the left ventricle

Interact Cardio Vasc Thorac Surg

Case report
A Foreign Body in the Heart Due to an Unusual Injury