Pyeon Taehee, Bae Hong-Beom, Choi Jeong Il, Kim Taeyeong, Kim Joungmin
Department of Anesthesiology and Pain Medicine, Chonnam University Hospital.
Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Medicine (Baltimore). 2020 May;99(19):e20058. doi: 10.1097/MD.0000000000020058.
A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years.
A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago.
A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE.
The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded.
After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications.
TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.
心脏异物可导致血栓形成或感染，但患者有时可能没有任何症状。诊断主要通过影像学检查进行。特别是，超声不仅有助于检测异物，还能用于观察血流动力学情况。然而，超声的缺点是在透声差产生阴影的部位无法使用。经食管超声心动图（TEE）在识别心脏后部结构方面优于经胸超声心动图（TTE），因为探头位于心脏后方的食管内。在此，我们报告一例在心脏手术期间通过TEE偶然发现左心房异物的病例。该异物20年来未引起任何症状或体征。
一名75岁重度三尖瓣反流女性患者在全身麻醉下接受三尖瓣置换术（TVR）。她20年前有二尖瓣置换术（MVR）和三尖瓣环成形术手术史。
TEE检查期间在左心房观察到一个高回声漂浮心脏异物。术前的X线、计算机断层扫描、TTE等影像学检查均未发现。
通过左心房切口肉眼确认了TEE发现的心脏异物。一个细长的异物位于从右上肺静脉至左心房处，被认为是20年前MVR手术期间使用的左心房导管。取出异物后，按计划进行TVR手术。
取出心脏异物并完成TVR手术后，患者按计划入住重症监护病房，随后转入普通病房，无任何并发症出院。
TEE对诊断心脏后部异物非常有用。围手术期进行的TEE检查应超出术前TEE检查结果再次确认的水平。如果检测到有留置导管，考虑到并发症风险，取出导管可能是合适的。
