Dynamic monitoring of a migrating and penetrating intracardiac foreign body by echocardiography perioperatively

Backgroud: Cardiac penetrating injuries caused by migrating foreign bodies are rare. The perioperative locating of these foreign bodies is challenging since their location may change with the continuous beat of the heart. Case presentation: We reported an interesting case of cardiac penetrating injury caused by a self-inflicted needle that migrated from the neck to the heart. The needle was dynamically monitored by both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) perioperatively, which showed a significant location change of the needle in the ventricular wall. In a few hours, the needle had moved into the right ventricle with a distance of 2.0cm. An emergency surgery was immediately carried out and the needle was successfully removed without open heart surgery and cardiopulmonary bypass (CPB). If there had been any delay, it would be possible that the needle might enter the right ventricle and was not visible on the surface of the visceral pericardium. The dynamic monitoring of the needle’s location using echocardiography helped clinical decisions and benefited the patient. Conclusions: Foreign bodies with sharp nature have a tendency to migrate though tissues and lead to serious complications. A real-time, continuous and accurate monitoring of cardiac foreign bodies is urgently needed. Echocardiography with a combination of both TTE and TEE help determination of optimal surgical method without radiation hazards, which is worth popularizing in clinical practice.