Management of Metallic Foreign Bodies in the Heart

Wang, M B Xiaoweng; Zhao, Xin; Du, Debin; Xiang, Xiaoyong

doi:10.1111/jocs.12005

Cited by 16 publications

(27 citation statements)

References 36 publications

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“…7,8 The most common location for a foreign body within the heart is the right ventricle, followed by the right atrium and pulmonary artery. 9 Interventricular septal involvement and left-sided involvement are much less common. 5 Diagnostic modalities for identifying cardiac foreign body include radiography, ECG, and CT scan.…”

Section: Discussionmentioning

confidence: 99%

“…15 Those procedures requiring the open approach can be done as a left lateral thoracotomy without cardiopulmonary bypass, or in cases with erosion into the myocardium or septum, open sternotomy and bypass may be required. 9 Early diagnosis and treatment of these injuries is essential because life-threatening complications can ensue if intracardiac foreign bodies are left untreated.…”

Section: Discussionmentioning

confidence: 99%

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Chest Pain and Dyspnea With a Piercing Diagnosis

Francescon

Mehta

Kosier

et al. 2019

Chest

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A patient presented to the ED with 2 days of chest pain radiating to the back. Symptoms were associated with dyspnea and diaphoresis. The patient had a significant history of self-inflicted stab wounds and retained foreign bodies. He was status-post multiple endoscopic removals and laparotomies. The patient was recently admitted to the hospital secondary to an abdominal foreign body removed by general surgery. The day of presentation the patient denied any new injuries. He had no history of cardiac disease or venous thromboembolic events. Review of systems was negative other than noted. His vital signs showed an initial BP 120/55, pulse rate 118, temperature 36.9 C, respiration rate of 20, and peripheral capillary oxygen saturation 97% on room air. His general appearance was significant for an ill-appearing, diaphoretic man. Cardiovascular examination was notable for sinus tachycardia with intact distal pulses and no detectable abnormal heart sounds. Respiratory examination revealed clear lungs and normal work of breathing. Abdominal examination revealed multiple well-healed scars without tenderness or peritoneal signs. The rest of his physical examination was unremarkable.On arrival to the ED, two large-bore IV lines were established. ST changes were noted on the monitor, prompting an ECG that revealed diffuse ST segment elevations. Troponin was elevated to 2.01. A bedside cardiac ultrasound was performed (Video 1).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chest Pain and Dyspnea With a Piercing Diagnosis

Francescon

Mehta

Kosier

et al. 2019

Chest

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“…[9] Since our patient refused the operational removal of the foreign body, we have decided to give prophylactic anticoagulation and antibiotic therapy. [1] Radiologic demostration of the foreign body is important to guide surgical treatment. Altough the chest radiograph confirms the nature of the injury, exact compartmental location should be assesed by computed tomography.…”

Section: Discussionmentioning

confidence: 99%

“…The symptoms due to a foreign body in the heart can present from hours to years. [1] These foreign bodies can be asymptomatic even after several years. [2] Most of the cases were accidental or self-inflicted due to an underlying psychiatric illness.…”

Section: Introductionmentioning

confidence: 99%

Bedside ultrasound diagnosis of intracardiac paperclip

Ünlüer

Karagöz

Topal

et al. 2014

J Emerg Trauma Shock

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Penetrating cardiac injuries are rarely reported in the literature. Foreign bodies are rarely seen in the heart and most patients with penetrating cardiac injuries die from hemorragic or pericardial tamponade before arriving at the hospital. Bedside ultrasonography is a highly valuable and readily learned tool that has expanded rapidly since its introduction more than 20 years ago. Our case was a 23-year-old convict brought to the emergency department (ED) with a history of continuous chest pain in the upper area of the left side of the chest for one week. Focused Cardiac Sonography (FOCUS) which was performed by emergency physician showed a strong echogenic linear structure with comet tail artifact, free floating in the mid-segment of the left ventricule. Exact localizations of the paperclips within the chest was obtained with multidetector computed tomography and one of them was seen in the left ventricular cavity. FOCUS plays a crucial role in these patients by diagnosing the injury and detecting the complications in emergency department.

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“…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]. Several types of FBs were retrieved from the heart such as bullets, shrapnel, catheters and migrating wires from peripheral vessels [3].…”

Section: Introductionmentioning

confidence: 99%

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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Management of Metallic Foreign Bodies in the Heart

Abstract: Management of the metallic foreign body in the heart remains controversial. Evaluation of possible methods for this issue and its possible treatments are discussed, the results of which may lead to a more effective strategy for management of intracardiac foreign bodies.

Cited by 16 publications

References 36 publications

Chest Pain and Dyspnea With a Piercing Diagnosis

Chest Pain and Dyspnea With a Piercing Diagnosis

Bedside ultrasound diagnosis of intracardiac paperclip

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

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