RATIONALE:A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS:A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS:A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS:The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES:After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS:TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.

译文

理由:心脏异物可能导致血栓形成或感染,但有时可能不会引起患者任何症状。诊断主要使用放射学检查进行。特别地,超声不仅可用于检测异物,而且可用于血液动力学发现。但是,超声波的缺点是由于渗透性差,不能在产生阴影的地方使用超声波。经食道超声心动图(TEE)优于经胸超声心动图(TTE)来识别心脏后部结构,因为该探头位于心脏后面的食道中。在这里,我们报告在心脏手术期间通过TEE在左心房偶然发现异物的情况。 20年来没有引起任何症状或体征。
患者注意事项:一名75岁的女性三尖瓣反流严重,在全身麻醉下接受了三尖瓣置换术(TVR)。她在20年前有二尖瓣置换术(MVR)和三尖瓣瓣环成形术手术的历史。
诊断:TEE检查期间在左心房观察到高回声的漂浮性心内异物。术前影像学检查(如X射线,计算机断层扫描,TTE)未检测到。
干预措施:通过TEE发现的心脏异物通过左心房切口视觉确认。一个长而稀的异物位于右心房的左心房右肺静脉,这被认为是20年前进行MVR手术时使用的左心房导管。清除异物后,计划进行的TVR操作继续进行。
结果:去除心内异物和TVR后,患者被送入重症监护病房,随后按计划进入普通病房,出院无任何并发症。
教训:TEE对于诊断心脏后部的异物非常有用。围手术期进行的TEE的检查应超出再次确认术前进行TEE的检查结果的水平。如果检测到保留的导管,考虑到并发症的风险,将其移除可能是合适的。

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