Discussion
Penetrating cardiac injury in childhood is extremely rare. The objects
usually are needles, bullets, grenade acupuncture or sometimes sewing
needles (3). In our case, the patient had symptoms of infective
endocarditis. What’s surprising is there was no cardiac tamponade after
trauma as we assume blood drained to the left pleural cavity. This is an
unusual case in that the thorn directly caused infective endocarditis.
The thorn was embedded in the left ventricle, penetrating from the apex
posteriorly. As it settled there, it was covered by a big clot
anteriorly and adhesions formed. Management for such cases is very
difficult and case dependent. As data concerning foreign bodies in the
heart is limited, hence no specific accredited guidelines or
recommendations are available. In symptom-free patients, surgery depends
on the type and place of the foreign body. Patients having foreign
bodies completely embedded or in the pericardial space or in the
myocardium usually remained asymptomatic for a while (4). The surgical
approach for removing the foreign body is individualized according to
the type of foreign body (5). Our patient was overall stable, so first
we focused on treating infective endocarditis to prevent life-long
complications, and to make sure the patient is in the best possible
condition for the surgery. Although the risk was high, surgery with
bypass was indicated to avoid a life -threatening situation. Possible
complications for such cases vary, and all are life threatening if the
patient is left untreated. Infective endocarditis and the presence of a
foreign body in the heart both contribute to thrombosis and then fatal
embolization. Also the foreign body can cause injury to the surrounding
vessels, and heart rhythm can be disturbed (3).
To our knowledge and recent literature, this is the first case with such
a presentation of a thorn with this measurement that is complicated by
infective endocarditis.