Intracardiac Sewing Needle in a Child
Intracardiac Sewing Needle in a Child
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儿童心内缝合针
DOI：
10.1007/s12098-018-2719-8
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Xiaoqiang Ding
中科院分区：
文献类型：
--
作者：
Jieru Cai;Huan Liu;Lai Wei;Xiaoqiang Ding
致编者：心内针引起的心脏损伤是一种罕见且可能危及生命的事件。由于其尖锐的性质，针头可以快速穿过组织，引起严重的并发症，如心脏填塞、感染、外周栓塞等[1,2]。我们代表的情况下，一个15岁的女孩入院的急诊科，因为持续两周的胸痛。入院前两天，她在另一家医院进行胸部计算机断层扫描（CT），发现胸部有三个针状不透射线结构：两个在胸壁，一个在右心室。然后病人被转到这家医院。经体格检查，生命体征稳定。左侧胸骨旁第三肋间隙有一5 mm瘢痕，触诊无异常皮肤。心音正常，无杂音、摩擦或跳动。其余的检查都很正常。除肌钙蛋白T轻度升高（0.069 ng/ml，基线< 0.03 ng/ml）外，血、尿常规分析未见明显异常。为了准确确定病因为心内针，排除其他疾病，我们做了一些辅助检查，如心电图、经胸超声心动图、冠状动脉CT血管造影、心脏CT（图1 a、b、c、d）。这些结果证实针状不透射线结构的尖端已经穿透右心室和室间隔，而针尾几乎完全穿透心脏。心内针可能是致命的，建议取出。由于较少的手术创伤和美容原因，我们进行了有限的开胸手术以取出针头（图1e）。该手术不需要体外循环，也不需要输血。病人恢复得又快又顺利。术后第5天出院，随访期间病情良好。
To the Editor: Cardiac injury caused by intracardiac needle is a rare and potentially life-threatening event. Owing to its sharp nature, needle can rapidly pass through the tissue and induce serious complications, such as cardiac tamponade, infection, and peripheral embolism [1, 2]. We represent case of a 15-y-old girl admitted to the emergency department because of ongoing chest pain for two weeks. Two days before admission, she was examined at another hospital where thoracic computed tomography (CT) was performed which revealed three needle-shaped radiopaque structures in the chest: two in the chest wall and one in the right ventricle. Then the patient was transferred to this hospital. On physical examination, her vital signs were stable. There was a 5-mm scar in the 3rd intercostal space on left parasternal region without abnormal skin on palpation. Heart sounds were normal and no murmurs, rubs, or gallops were detected. The remainder of the examination was normal. There were no apparent abnormal results in routine blood and urine analyses, except a mild increase in troponin T (0.069 ng/ml, baseline< 0.03 ng/ml). In order to accurately fix the cause as intracardiac needle and exclude other diseases, some auxiliary examinations, such as ECG, transthoracic echocardiography, coronary CT angiography and cardiac CT were performed (Fig. 1 a,, b, c and d). These results confirmed that the tip of the needle-shaped radiopaque structure had penetrated the right ventricle and the interventricular septum, while needle tail almost completely penetrating into the heart.An intracardiac needle is likely to be lethal and its extraction is recommended. For less surgical trauma and cosmetic reasons, a limited thoracotomy was performed to remove the needle (Fig. 1 e). The procedure was performed without cardiopulmonary bypass and no transfusion was needed. The patient recovered quickly and smoothly. She was discharged on day 5 after surgery and remained well during follow-up.
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