Utility of precordial, epicardial and transesophageal two-dimensional echocardiography in the detection of intracardiac foreign bodies

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

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.

Transesophageal echocardiographic (TEE) evaluation of intracardiac and pericardial masses

Transesophageal echocardiography has assisted the detection of intracardiac masses and, in certain cases, aided our ability to define the specific type of mass. This technique, when coupled with three-dimensional imaging, may help to define infiltration of the wall. TEE aids in the intraoperative management of cardiac tumors.

Recurrent pericardial effusion due to gunshot wound of the heart in a hemodynamically stable child--a case report

A 12-year-old girl presented with recurrent pericardial effusion due to firearm pellet injury to the left ventricle. The pellet was localized by two-dimensional echocardiography within the left ventricular apical wall. Since the patient was asymptomatic, left ventriculotomy was avoided to extract the pellet and only pericardial tube drainage was carried out. A slightly elevated blood lead level of the patient was alarming for potential subsequent lead poisoning due to retained pellets.

[The assessment of cardiac involvement in a case of a thoracic injury from a firearm]

We report the case of a patient with a gunshot wound in the chest with a multiple small-caliber intrathoracic projectiles. The different noninvasive techniques employed to evaluate the anatomical location of these projectiles are discussed, together with their cardiac structural repercussions. The data provided by a simple chest X-ray, Computed Tomography (CT) and transthoracic echocardiography are commented on. A simple chest X-ray was unable to discern the location of the projectiles, in contrast to CT, which was able to identify both the number of projectiles and their location. The information provided was enhanced by transthoracic echocardiography, particularly in relation to those projectiles situated in anterior cardiac regions.

Echocardiographic imaging of a basket catheter for mapping and ablation of ventricular tachycardia in pigs

Our objective was to assess the feasibility and efficacy of the recently described left ventricular simultaneous deployment of a new multi-electrode mapping catheter and a standard radio-frequency ablation catheter in pigs, with echocardiography monitoring and fluoroscopy guidance. Introduction and deployment of both catheters in five healthy anesthetized pigs were guided on-line by fluoroscopy and monitored with transthoracic echocardiography. Heart rate and femoral blood pressure were also continuously monitored. Both catheters were deployed for up to 5 hours. Three animals underwent three to five radio-frequency energy applications. Left ventricular dimensions obtained from long axis two-dimensional echocardiography imaging before and after basket-catheter deployment in the left ventricular cavity, were 3.9 +/- 0.3 versus 3.7 +/- 0.6 cm at end-diastole and 2.8 +/- 1.1 versus 2.6 +/- 0.8 cm at end-systole, respectively (mean +/- standard error of the mean, p > 0.05). Shortening fraction measured from long axis two-dimensional echocardiography images before and after catheter deployment was 28% +/- 10% versus 25% +/- 5%, respectively (mean +/- standard error of the mean, p > 0.05). Additional findings included the following: (1) good conformation of the multi-electrode mapping catheter to the left ventricular dimensions during diastole; (2) absence of catheter-induced aortic and/or mitral insufficiency, as well as left ventricular outflow tract obstruction; (3) absence of damage to mitral and aortic valves or to the left ventricular wall. Postmortem examination and hemodynamic measurements confirmed these findings and showed only minor subendocardial hemorrhages; (4) radio-frequency energy application produced intracavitary bubbles, which were demonstrable echocardiographically, enabling identification of the gross anatomic location of ablation sites. Echocardiography during simultaneous deployment of multi-electrode mapping catheter and radio-frequency ablation catheters enables estimation of mechanical interaction with the left ventricle and detects interaction with myocardial/valvular function. During radio-frequency energy application, bubble production may identify gross anatomic location of ablation.

Use of transesophageal echocardiography in the detection and consequences of an intracardiac bullet

A 17-year-old male sustained a gunshot injury to the chest. Transesophageal echocardiography showed the presence of a retained bullet in the pericardium and the absence of an intracardiac shunt, which provided important information for the treatment of the patient.

Echocardiographic features of embolized inferior venacaval filter to the right ventricle--a case report

The authors describe two-dimensional echocardiographic features of an inferior venacaval filter that migrated to the right ventricle. As far as they can determine, this is the first description of the echocardiographic aspects of this clinical entity.