Objective: We describe a case of an intracardiac shrapnel in a 45 years old patient, for discussion of surgical indications in cardiac foreign bodies.
Methods: The patient was a victim of a terror attack in her country, suffering a penetrating trauma. She was transferred to a local hospital, and diagnosed with a translucent foreign body, suspected to be in her abdomen. Following which she underwent an exploratory laparotomy which demonstrated an injured bowel and a tear in the left diaphragm (which were repaired). The foreign object was not extracted.
Following the operation, due to pericardial effusion, the patient was evacuated from her country and referred for our hospital. On arrival, Echocardiogram demonstrated an echogenic shadow 2 cm in size located in the right ventricular apex near the septum, with small pericardial effusion. The patient was taken for the operating room.
Results: In the operating room, TEE demonstrated intact atrial and ventricular septae, and the above described foreign body. Through a median sternotomy, the pericardium was opened with evacuation of a medium amount of old bloody effusion. On palpation of the right ventricular apex, a hard object could be palpated. An epicardial ultrasound demonstrated and assisted in locating the foreign object.
Utilizing an extracorporeal circulation, a right ventriculotomy was made through the diaphragmatic ventricular wall immediately above the object. And the foreign object could be thereafter evacuated. Postoperative course was without complications.
Conclusions: Intracardiac shrapnel is not a common finding, and literature is lacking in this area. The case mentioned above was safely managed surgically. Operation was performed due to the size of the object and possible damage of a metal object in the heart.
The indications and guidelines for intervention in intracardiac foreign bodies should be further studied and established.
