Case Report:
A 3 years old child of average body mass index and normal developmental
milestones with history of falling down on his abdomen was referred to
paediatric cardiology department with recurrent chest pain for 3 months
that was not managed by seeking many medical experts. X-ray revealed
nothing and he was treated by simple analgesia. Echocardiography showed
a thorn within the left ventricle that’s penetrating from the apex
posteriorly covered by big clot anteriorly that measures (15cm × 11cm)
and was diagnosed as foreign body that was complicated by infective
endocarditis (Figure 1 ). The patients was put on the medical
treatment of infective endocarditis according to the international
regimen for 2 to 3 weeks, followed by inflammatory markers follow-up and
then he was shifted to operation room to undergo median sternotomy which
showed normal pericardium apart from adhesions between chest and
diaphragm. The patient was put on by pass after we arrest the heart;
adhesions were removed completely then they revealed the definitive body
(Figure 2 ), foreign body reaction and a whole of a big slider
thorn come out. We went into trans-atrial approach through left atrium
and then through mitral valve with organized thrombus, we washed with
antibiotic solution, we checked that’s mitral valve is normal then we
closed. Tricuspid valve was tested and was found to be normal so right
atrium was closed. We debride the place of foreign body entry, then we
closed using pericardium strips of two layers warmed and separated.
Haemostasis was secured and the chest was closed with two chest tubes.
Patient was sent to paediatric ICU under cover of broad spectrum
antibiotics, antifungal and analgesia on need. Child was extubated
successfully on the next day and was followed-up for 1 week clinically,
with laboratory markers and then was sent home after Echo was done on
the day of discharged which showed completely normal heart. The patient
was told to be seen on refer clinic after 1 month of discharge.