Self-Mutilation: Needles within the heart Bernhard Scharinger
Intracardiac foreign bodies are rare and can lead to life-threatening complications. Posttraumatic and self-inserted foreign bodies within the heart are either a result of direct penetration due to local trauma, migration to the heart via the venous system or migration through adjacent tissue and are far less frequent.
Affected patients present with a wide variety of symptoms from having no symptoms to having fever, chest pain and shortness of breath, with dyspnea and arrhythmias being the most common.
Diagnosis consists of several modalities including chest x-ray, echocardiography and computed tomography to accurately localize the foreign body and to diagnose possible complications such as cardiac effusion and cardiac tamponade. Therapeutic options involve either surgical or percutaneous removal of the foreign object or conservative management. However, optimal therapeutic management is controversial and the need for surgical removal of intracardiac foreign objects depends on location, size and shape of the foreign body and the severity of symptoms. Further, the risk of complications caused by the foreign body compared to the risk of surgical removal has to be considered. Therefore, therapeutic management should follow an individualized approach.
We report a case of a 25-year-old woman who self-inserted needles into her chest due to a psychiatric disorder. The patient presented to emergency clinic with shortness of breath. Computed tomography of the thorax showed needles in the aortic root and the left-ventricular myocardium with subsequent hemopericardium. Inspection of the second needle in the aortic root showed that it had caused a defect in the right leaflet of the aortic valve with signs of endocarditis and subsequent aortic valve insufficiency.
Surgical removal of foreign objects was carried out using cardiopulmonary bypass and mechanical aortic root replacement. Primary reconstruction of the aortic valve was found to be insufficient with the consequence of a mechanical aortic valve replacement. Postoperative course was uneventful. The patient left the hospital two weeks after surgery.
DOI: https://ysmu.am/v2/wp-content/uploads/2023/09/14-shag.pdf The New Armenian Medical Journal Vol.14 (2020), Nо 2 105-107
