Actis Dato Guglielmo Maria, Arslanian Anna, Di Marzio Paolo, Filosso Pier Luigi, Ruffini Enrico
Division of Cardiac Surgery, University of Turin, 3 Via Genova, 10126 Turin, Italy.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):408-14. doi: 10.1016/s0022-5223(03)00399-4.
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.
Posttraumatic or iatrogenic foreign bodies in the heart can be treated either conservatively or surgically. Controversy exists about optimal management.
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).
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.
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.
本文介绍并讨论了我们在心脏创伤性和医源性异物方面的经验，并对该主题的文献进行了综述。
心脏创伤性或医源性异物可采用保守治疗或手术治疗。关于最佳治疗方法存在争议。
对1955年至2000年间观察到的14例心脏创伤性或医源性异物病例进行了研究。我们的病例系列包括以下情况：子弹进入右心室或左心室（4例）；针头进入左心室、心房和肺动脉（3例）；右心室、右心房或肺动脉中残留的导管碎片（4例）；手榴弹碎片进入右心房（1例）；圆锯碎片进入右心室（1例）；二尖瓣分离环进入左心房（1例）。
当异物位于心腔内时（1例）；当存在诸如栓塞、心律失常或感染等相关危险因素时（3例）；以及当存在包括心脏压塞（2例）、心律失常（1例）、发热（2例）或焦虑（1例）等相关体征或症状时，会取出异物。通过开胸手术（7例）或胸骨切开术（2例）取出异物，其中3例使用了体外循环，其余未使用，或经皮取出（1例）。4例无症状患者接受了保守治疗，在中位随访20年时无并发症证据。
心脏异物的处理应个体化：（1）有症状的异物，无论其位置如何，均应取出；（2）受伤后立即诊断出且伴有相关危险因素的无症状异物应取出；（3）无相关危险因素或受伤后诊断较晚的无症状异物可保守治疗，特别是如果它们完全嵌入心肌或心包。
