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J Thorac Cardiovasc Surg 2003;126:408-414
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature

^a Division of Cardiac Surgery, University of Torino, Torino, Italy
^b Division of Thoracic Surgery, University of Torino, Torino, Italy

Received for publication March 18, 2002; revisions received April 3, 2002; revisions received April 17, 2002; accepted for publication April 23, 2002.

^* Address for reprints: Enrico Ruffini, MD, Thoracic Surgery, University of Torino, 3, Via Genova 10126, Torino, Italy
enrico.ruffini{at}unito.it

OBJECTIVE: Our experience with posttraumatic and iatrogenic foreign bodies in the heart is presented and discussed along with a review of the literature on this subject.

SUMMARY BACKGROUND DATA: Posttraumatic or iatrogenic foreign bodies in the heart can be treated either conservatively or surgically. Controversy exists about optimal management.

METHODS: Fourteen cases of posttraumatic or iatrogenic foreign bodies in the heart observed between 1955 and 2000 were studied. Our series includes the following: bullets into the right or left ventricle (4 cases); needles in the left ventricle, atrium, and pulmonary artery (3 cases); retained catheter fragments in the right ventricle, right atrium, or in the pulmonary artery (4 cases); a grenade fragment into the right atrium (1 case); a circular saw fragment into the right ventricle (1 case); and a commissurotomy ring into the left atrium (1 case).

RESULTS: Foreign bodies were removed when in the cardiac cavities (1 case); when in the presence of associated risk factors like embolism, arrhythmia, or infection (3 cases); and when in the presence of associated signs or symptoms including cardiac tamponade (2 cases), arrhythmia (1 case), fever (2 cases), or anxiety (1 case). Removal was accomplished by a thoracotomy (7 cases) or sternotomy (2 cases), with (3 cases) or without cardiopulmonary bypass, or percutaneously (1 case). Four asymptomatic patients were conservatively treated and have no evidence of complications at a median follow-up of 20 years.

CONCLUSIONS: The management of foreign bodies in the heart should be individualized: (1) symptomatic foreign bodies should be removed irrespective of their location; (2) asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; (3) asymptomatic foreign bodies without associated risks factors or diagnosed late after the injury may be treated conservatively, particularly if they are completely embedded in the myocardium or in the pericardium.

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