Hassett A, Moran J, Sabiston D C, Kisslo J
J Am Coll Cardiol. 1986 May;7(5):1151-6. doi: 10.1016/s0735-1097(86)80237-6.
Nine consecutive patients with penetrating missile wounds of the heart were evaluated by M-mode and two-dimensional echocardiography for localization of retained missile fragments noted to be moving in synchrony with the heart by fluoroscopy. Echocardiography precisely located all 12 moving fragments: 2 in the pericardium, 5 in the anterior right ventricular wall, 3 in the free left ventricular wall, 1 in the interventricular septum and 1 in the right posterior atrioventricular groove. Five patients had echocardiographic evidence of pericardial effusion and only one manifested a wall motion abnormality, indicating that direct myocardial perforation does not always result in detectable intrapericardial bleeding or asynergy. Localization of the missile fragments to be in danger of endocardial perforation, in danger of eroding the right coronary artery and creating a clinically unsuspected membranous ventricular septal defect led directly to surgical intervention in three different patients. In all three, intraoperative echocardiography quickly localized the missile fragments and significantly reduced patient cardiopulmonary bypass time. In the remaining six patients, localization of missile fragments well within the myocardium with no danger of erosion led to decisions against surgical removal.
对9例连续的心脏穿透性导弹伤患者进行了M型和二维超声心动图检查，以定位经荧光透视发现与心脏同步移动的残留导弹碎片。超声心动图精确地定位了所有12个移动碎片：2个位于心包内，5个位于右心室前壁，3个位于左心室游离壁，1个位于室间隔，1个位于右后房室沟。5例患者有超声心动图证据显示心包积液，只有1例表现出壁运动异常，这表明心肌直接穿孔并不总是导致可检测到的心包内出血或运动不协调。将导弹碎片定位为有发生心内膜穿孔的危险、有侵蚀右冠状动脉并造成临床上未被怀疑的膜性室间隔缺损的危险，直接导致3例不同患者接受手术干预。在所有3例患者中，术中超声心动图迅速定位了导弹碎片，并显著缩短了患者的体外循环时间。在其余6例患者中，导弹碎片位于心肌内且无侵蚀危险的定位导致决定不进行手术取出。
