A living withness of the history: a cardiac shrapnel fragment (Rapor)

Corresponding author: Koray Ak

E-mail: korayak@marmara.edu.tr Marmara Medical Journal 2005;18(2);101-102

SHORT COMMUNICATION

A LIVING WITHNESS OF THE HISTORY: A CARDIAC SHRAPNEL FRAGMENT

1

Department of Cardiovascular Surgery, School of Medicine, Marmara University, Istanbul, Turkey 2 Department of Cardiovascular Surgery, School of Medicine, Foundation Hospital, Marmara University, Istanbul, Turkey

ABSTRACT

A 76 -year- old Turkish Korean veteran suspected of having coronary artery disease, underwent coronary angiography. A foreign body was incidentally detected within the heart. The patient had joined the Korean War 55 yaers ago and had been injured by an explosive blast. The foreign body was one of the shrapnel fragments which had remained asymptomatic within the heart for 55 years.

Keywords: Foreing body, Cardiac sharapnel fragment, Korean war

TARİHİN YAŞAYAN BİR TANIĞI:KARDİYAK ŞARAPNEL PARÇASI

ÖZET

76 yaşındaki savaş gazisi bir hastaya koroner arter hastalığı şühhesi ile koroner anjiografi yapıldı ve raslantısal olarak kalbin içerisinde yabancı bir cisim tespit edilmiştir. Hasta 55 yıl önce Kore savaşına katılmış ve yakınında gerçekleşen bir patlama ile yaralanmıştır. Şarapnel parçasının 55 yıldır hiçbir bulgu vermeden kalbin içinde kaldığı görüldü.

Anahtar Kelimeler: Yabancı cisim, Kardiyak şarapnel parçası, Kore savaşı

CASE

A 76-year-old veteran with a history of injury due to explosion of a blast at Korean War 55 years ago was referred to our clinic for the evaluation of suspected coronary artery disease (CAD). He had complained of chest pain and dyspnea for 1 year on admission. He also had a history of hyperlipidemia as a risk factor for CAD. His physical examination revealed small areas of scar tissue over the anterior chest wall. Physical examination of all systems was completely normal. The patient stated that he underwent surgical exploration at the time of injury, and ten shrapnel fragments had been removed immediately by operation . The coronary angiography demonstrated severe two vessel CAD. Cineangiography also incidentally revealed a foreign particle measuring approximately 0.5 X 0.7 cm that was moving with each cardiac cycle which suggested that this object is rather intracardiac (Fig. 1). A decision to treat his underlying CAD with coronary artery bypass grafting was made. The operation was performed

by on-pump cardiopulmonary bypass. After aortic cross clamping, the right atrium was opened and interatrial septum was palpated. A metallic substance which was totally covered by endothelial cells and buried into the interatrial septum was detected. Two vessel coronary artery bypass grafting operation was performed (a saphenous vein graft to the left anterior descending coronary artery and a saphenous vein graft to the first obtuse marginal branch of the circumflex coronary artery) and the foreign substance was not removed. The rest of the operation was completed in a standard fashion without any complication and the patient was discharged from the hospital on postoperative day 5. Acute mortality of patients with cardiac penetrating injuries is reported to be as high as 50% and most of these patients die at the time of the injury 1_{. We think this case was interesting}

because the patient remained asymptomatic for 55 years and brought the Korean War to our minds once more.

Marmara Medical Journal 2005;18(2);101-102 Koray Ak, et al.

A Living Withness of The History: A Cardiac Shrapnel Fragment

Fig. 1: Coronary angiogram: Left anterior oblique projection

of the right coronary artery.

Arrow indicates the shrapnel fragment.

REFERENCES

1. Campbell NC, Thomson SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997; 84:1737-1740.