An Intracardiac Foreign Body: A Retained Suture in an Operated Infant with Congenital Heart Disease

Intra-cardiac foreign bodies are a rare occurrence and there is minimal literature on retention of sutures following cardiac surgery. This is an unusual case of a retained intracardiac prolene suture following surgical correction of Tetralogy of Fallot in a 6 month old patient. The patient had an uneventful post-surgical recovery but a foreign body was identified on a routine post-operative transthoracic echocardiogram. Due to the uncertain nature of the structure, the patient underwent fluoroscopy, chest X-ray and a cardiac CT which were unable to identify the nature of the structure. The best modality for identification was echocardiography, which consistently demonstrated the origin, and course of the suture. Due to a high level of suspicion and consistent findings on echocardiograms, the patient underwent surgical exploration 10 days following surgery and a prolene suture was identified originating in the right upper pulmonary vein extending though the mitral and aortic valve to the transverse aortic arch. This was thought to be from the purse string suture used for the left ventricular vent inserted via the right upper pulmonary vein during surgery.

Guidelines for the Discovery of an Intracardiac Foreign Body Through a Case of Metal Tip Migration to the Right Ventricle after Tibia Osteosynthesis

Case: We report a case of a metallic foreign body migration from the lower limb to the right ventricle. A metal tip of 5x3mm was discovered during a cardiac investigation for a ventricular extrasystole. A few months earlier, the patient had a tibia osteosynthesis for fracture. Conclusion: We propose guidelines in case of a cardiac foreign body detection. A conservative treatment or surgical removal can be discussed depending on the clinical features, the anatomical situation and the shape of the foreign body.

Dynamic monitoring of a migrating and penetrating intracardiac foreign body by echocardiography perioperatively

Backgroud: Cardiac penetrating injuries caused by migrating foreign bodies are rare. The perioperative locating of these foreign bodies is challenging since their location may change with the continuous beat of the heart. Case presentation: We reported an interesting case of cardiac penetrating injury caused by a self-inflicted needle that migrated from the neck to the heart. The needle was dynamically monitored by both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) perioperatively, which showed a significant location change of the needle in the ventricular wall. In a few hours, the needle had moved into the right ventricle with a distance of 2.0cm. An emergency surgery was immediately carried out and the needle was successfully removed without open heart surgery and cardiopulmonary bypass (CPB). If there had been any delay, it would be possible that the needle might enter the right ventricle and was not visible on the surface of the visceral pericardium. The dynamic monitoring of the needle’s location using echocardiography helped clinical decisions and benefited the patient. Conclusions: Foreign bodies with sharp nature have a tendency to migrate though tissues and lead to serious complications. A real-time, continuous and accurate monitoring of cardiac foreign bodies is urgently needed. Echocardiography with a combination of both TTE and TEE help determination of optimal surgical method without radiation hazards, which is worth popularizing in clinical practice.

Dynamic monitoring of a migrating and penetrating intracardiac foreign body by echocardiography perioperatively

Backgroud: Cardiac penetrating injuries caused by migrating foreign bodies are rare. The preoperative and intraoperative locating of these foreign bodies is challenging since their location may change with the continuous beat of the heart. Case presentation: We reported a case of cardiac penetrating injury caused by a self-inflicted needle that migrated from the neck to the heart. The needle was dynamically monitored by both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) perioperatively, which showed a significant location change of the needle in the ventricular wall. The migrating distance of the needle moving into the right ventricle was about 2.0cm. The dynamic monitoring of the needle’s location using echocardiography helped clinical decisions and benefited the patient. Conclusions: Foreign bodies with sharp nature have a tendency to migrate though tissues and lead to serious complications. Echocardiography with a combination of both TTE and TEE has a unique advantage in providing real-time, continuous and accurate monitoring of cardiac foreign bodies. It helps to determine optimal surgical method without radiation hazards, which is worth popularizing in clinical practice.

STRANGE CARDIAC COMPLICATION AFTER MEDIAN EVENTRATION SURGERY

A 51-year old patient comes to the hospital complaining of 20-30 bowel movements every day andabdominal pain following the introduction of a new medication for his cardiological problems(notable aspirin). His relevant medical history shows antecedents of hemorrhagic recto-colitis,non-stented coronaropathy, and a colectomy performed more than 10 years before. The diagnosiswas simple to make following laboratory, imagistic and clinical investigations – pouchitis andmedian eventrations following the prior surgery. The real problem appeared the next day followinghis eventration cure – cardiac tamponade in the context of antiplatelet medication. The patient wassuccessfully managed by the cardiothoracic surgeons. An intracardiac foreign body was found andeliminated during the intervention. Taking into consideration the fact that the patient had beentaking antiplatelet medication for almost a month, it is very likely that the foreign body hadmigrated there during or after the corrective surgical procedure for the eventration and created thehemopericardium in this particular context.