Intracardiac foreign bodies: Diagnosis and management

Valeh Memmedov 1 * , Anar Emrah 1, Ziya Shahaliyev 1, Javid Ibrahimov 1
More Detail
1 Cardiovascular Surgery Department, Republican Diagnostical Center, Baku, Azerbaijan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 5, pp. 68-71. https://doi.org/10.23950/jcmk/13764
OPEN ACCESS 841 Views 803 Downloads
Download Full Text (PDF)

ABSTRACT

Introduction: As a result of gunshot wounds due to a bullet or shrapnel entering the system of arteries or veins, direct wounds of the heart or vascular structures, as well as embolisms may occur. After entering one of the systemic veins, the bullet or shrapnel can enter the right heart or the pulmonary artery. Shrapnel embolism is a rare condition, usually asymptomatic and is detected accidentally during routine examinations. Due to the fact that the intensity of occurrence of this type of cases is quite rare, it was decided to present such clinical cases.
Material and methods: This article reports about 3 patients with intracardiac foreign body. All 3 patients took part in the battles during the Second Karabakh War and were hospitalized as a result of shrapnel wounds received in different parts of the body. In each of the patients, the lesion area was different, but as a result of venous migration, the movement of a foreign body (metal fragment) in the heart cavity was noted. In two patients, the foreign body was removed by open surgery (connection to a heart-lung machine) due to the presence of symptoms, but one patient was under observation due to the absence of symptoms.
Results: Bullet or shrapnel embolism is a very rare complication of gunshot wounds, occurring in about 0.3% of cases. These emboli often cause antegrade migration into the arterial system. However, in about 20% of cases, migration into the venous system can also occur. Venous embolism often results in foreign body migration into the right heart or the pulmonary artery. The diagnosis in these cases is often established by chance, but in some cases, arrhythmias and valve defects can occur due to exposure to a foreign body. The identification of such cases depends on the symptoms. A foreign body can be removed by an open method, as well as by invasive methods. In some cases, it is possible to keep the foreign body under control when it does not cause any symptoms.
In the clinical cases we mentioned, we also mentioned the management of cases of foreign bodies entering the venous system from peripheral zones of penetration.
Keywords: cardiac trauma, intracardiac foreign body, foreign body migration

CITATION

Memmedov V, Emrah A, Shahaliyev Z, Ibrahimov J. Intracardiac foreign bodies: Diagnosis and management. J CLIN MED KAZ. 2023;20(5):68-71. https://doi.org/10.23950/jcmk/13764

REFERENCES

  • Leitman M, Vered Z: Foreign bodies in the heart. Echocardiography. 2015; 32:365-71. https://doi.org/10.1111/echo.12795
  • Nagy KK, Massad M, Fildes J, Reyes H. Missile emboliza-tion revisited: a rationale for selective management. Am Surg. 1994;60:975-9.
  • Michelassi F, Pietrabissa A, Ferrari M, Mosca F, Vargish T, Moosa HH. Bullet emboli to the systemic and venous circulation. Surgery. 1990; 107:239-45. https://doi.org/10.1002/bjs.1800770432
  • Schroeder ME, Pryor HI, Chun AK, Rahbar R, Arora S, Vaziri K. Retrograde migration and endovascular retrieval of a venous bullet embolus. J Vasc Surg. 2011; 53:1113-5. https://doi.org/10.1016/j.jvs.2010.11.046
  • Symbas PN, Picone AL, Hatcher CR & Vlasis-Hale SE. Cardiac missiles. A review of the literature and personal experience. Annals of Surgery. 1990; 211:639–647.
  • Michelassi F, Pietrabissa A, Ferrari M, Mosca F, Vargish T &Moosa HH. Bullet emboli to the systemic and venous circulation. Surgery. 1990; 107:239–245. https://doi.org/10.1002/bjs.1800770432
  • Lundy JB, Johnson EK, Seery JM, Pham T, Frizzi JD & Chasen AB. Conservative management of retained cardiac missiles: case report and literature review. Journal of Surgical Education. 2009; 66:228–235. https://doi.org/10.1016/j.jsurg.2009.04.002
  • Elsner D. Images in cardiology. Penetrating heart injury from Second World War. Heart. 2001; 86:323.
  • Amsel BJ, Van der Mast M, De Bock L, van Haasen R & Beeckman C. The importance of two-dimensional echocardiography in the location of a bullet embolus to the right ventricle. Annals of Thoracic Surgery. 1988; 46:102– 103. https://doi.org/10.1016/S0003-4975(10)65865-1
  • Actis Dato GM, Arslanian A, Di Marzio P, Filosso PL & Ruffini E. Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature. Journal of Thoracic and Cardiovascular Surgery. 2003. https://doi.org/10.1016/S0022-5223(03)00399-4