title: Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature.
abstract: 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.
  
  
  BACKGROUND
  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.
authors.affiliation: Division of Cardiac Surgery, University of Turin, 3 Via Genova, 10126 Turin, Italy.
authors.forename: Guglielmo Maria
authors.initials: GM
authors.lastname: Actis Dato
authors.forename: Anna
authors.initials: A
authors.lastname: Arslanian
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Marzio
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000150:complications*; D006321:Heart; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged