Intracardiac foreign body resulting from a transmediastinal gunshot mimics an extracardiac foreign body: An image presentation

Fu, Hsun-Yi; Ting, M.; Wang, Yi-Chia; Yu, Hsi‐Yu

doi:10.1016/j.jfma.2017.05.016

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…Several case reports have described the successful removal of intracardiac FBs using CPB [5,9,11,12]. Our results are in accordance with the above-mentioned findings to avoid bullet embolization and traumatic intracardiac defects, along with subsequent heart failure [1,2,7]. Percutaneous removal was reported with catheter fragments and should be performed as preliminary therapy, not prohibiting consequent surgical procedure [15,18,19].…”

Section: Discussionsupporting

confidence: 87%

“…Fever might result from contamination of pericardium or endocardium or sepsis, particularly from infected fragments if the patient was conservatively treated [12]. Patient history, chest x-ray films, chest multislice CT scan, TTE, and cardiac fluoroscopy were helpful tools in the diagnosis and exact orientation of intracardiac FBs [1,9,13]. The principal goals of management of intracardiac FBs are saving the lives of the patients, removing the FBs, and preventing future complications.…”

Section: Discussionmentioning

confidence: 99%

“…CPB allows greater safety and upsurges the patient survival as it allows still bloodless field when the FBs can be retained in a heart cavity or transfixing the heart or have difficult location as near left anterior descending coronary artery as described in our patients. In addition, closure of cardiac defects caused by FBs penetration can be repaired with the use of CPB [1].…”

Section: Discussionmentioning

confidence: 99%

“…Intracardiac foreign bodies (FBs) are serious traumatic injuries with high mortality and are technically challenging [1]. Intracardiac FBs have several complications, and the prompt diagnosis and surgical intervention are required to prevent adverse consequences [2].…”

Section: Introductionmentioning

confidence: 99%

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The use of cardiopulmonary bypass in the extraction of intracardiac foreign bodies

Mostafa¹

2019

Egypt. Cardiothoracic. Surg.

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Background: Intracardiac foreign bodies (FBs) are uncommon and have diverse presentations. The objectives of this study were to assess the types and presentation of intracardiac FBs and to evaluate the use of cardiopulmonary bypass (CPB) in their extraction. Methods: A retrospective descriptive study was carried out on 12 patients with a history or radiological evidence of a foreign body in the heart or the great vessels who were admitted between 2013 and 2018. Sternotomy was performed in 8 patients and left anterior thoracotomy in 4 patients. CPB was used in 4 patients with cardioplegic cardiac arrest. Aorto-bicaval cannulation was performed in 3 patients and femero-femoral bypass in 1 patient. Results: The mean age of our patients was 32.7 ±21.7 years (range 2-62 years), six were males. Six different intracardiac FBs were reported including retained bullets (n= 3), migrated catheter piece (n=3), sewing needles (n=3), displaced pacemaker lead (n= 1), circular saw (n=1) and missed pigtail catheter after pericardiocentesis (n=1). Recovery from cardiopulmonary bypass was smooth, and no hospital complications were reported. The mean duration of postoperative mechanical ventilation in all sternotomy patients was 7.8 ± 6.7 hours (5 ±2.1 in CPB patients and 10.7±8.9 in non-CPB). The duration of hospital stay in CPB cases vs. non-CPB was (5.5±1.3 vs. 5.7±0.9 days). No postoperative wound infection nor sternal dehiscence were reported. One baby who had lateral thoracotomy died on the fifth postoperative day because of severe gastroenteritis. No residual pericardial or pleural collection were reported in 6 months follow-up period. Conclusions: Retrieval of intracardiac FBs can be performed safely with low morbidity and mortality. The use of CPB did not increase morbidity or mortality. Removal of all types of intracardiac FBs is recommended to avoid complications

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of cardiopulmonary bypass in the extraction of intracardiac foreign bodies

Mostafa¹

2019

Egypt. Cardiothoracic. Surg.

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Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications

et al. 2023

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Penetrating injuries of the heart, named penetrating cardiac injury (PCI), may cause hemorrhagic shock as well as cardiac tamponade, leading to death if not treated immediately. This systematic review aims to highlight the main aspects of penetrating cardiac injuries after firearm wounds. The cases of 39 subjects (age 37.05 + 15.4) were selected (6 fatal cases). Specifically, 4/39 cases involved subjects under 18 y.o.; analyzing the entrance wound, in 30/39 cases it was located in the anterior chest, 4/39 in the posterior chest, 3/39 in the shoulder/axilla area, 1/39 in the neck, and 1/39 in the pelvis (gluteus). The exit wound was found in only 3/39 cases. Several factors may influence the prognosis: firstly, prompt intervention represents a crucial point, then considering the complications related to PCI, the most important are myocardial infarction, and projectile migration with embolization. The mortality rate is related to: (1) area and severity of the heart injury; (2) duration of transport and intervention; (3) contemporary lesion to other organ/s; (4) the quantity of blood lost; (5) and presence/absence of cardiac tamponade. Based on these findings, a correct approach in the management of PCI may be considered important from a forensic point of view, both as regards to medical liability and from the trial perspective.

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Intracardiac foreign body resulting from a transmediastinal gunshot mimics an extracardiac foreign body: An image presentation

Cited by 2 publications

References 12 publications

The use of cardiopulmonary bypass in the extraction of intracardiac foreign bodies

The use of cardiopulmonary bypass in the extraction of intracardiac foreign bodies

Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications

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