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.