We read with great interest the paper by Pan et al. regarding a bullet embolization to the right ventricle through an aorto-caval traumatic fistula in a 19-year old patient [1]. The foreign body was removed uneventfully under cardiopulmonary bypass. Orthopaedic materials such as cement [2] and Kirschner wires [3–4] are among the most common iatrogenic materials that can migrate to the heart chambers. We recently published the case of an 80-year old female patient with a Kirschner wire in her right ventricle [3]. We would like to point out several important points concerning the mechanism of migration of foreign bodies to the heart.
As stated by the authors [1], foreign bodies can enter venous system through a direct protrusion into the lumen or by a slower erosion of the vascular wall. In this case scenario, the foreign body migrates to the heart from a peripheral vein and ultimately lodges in the right heart chambers or the pulmonary artery vasculature. Direct penetration of the foreign bodies with sharp extremity is another possible explanation of migration of these devices to the heart. The migration is due to regional bone resorption, muscle activity, gravity and negative intra-thoracic pressure [5]. They can eventually puncture the heart after passing through adjacent structure and muscles causing pericardial effusion or pericarditis.
To avoid potential Kirchner wire migration, several safety measures should be taken: bending the subcutaneous ends of the pins, rendering it properly secured, removing all devices after definitive healing and bone fixation, and following these patients up on a regular basis. Potential migration may be prevented by applying these simple measures.
Conflict of interest: none declared.
References
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