CASE REPORTS
A Piece of Glass in the Heart
Xiubin Yang, MD, and Xiangdong Shen, MD
Department of Cardiovascular Surgery, Cardiovascular
Institute and Fu Wai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
Most posttraumatic foreign bodies are metal objects in
the heart, such as bullets and needles; nonmetal objects
are very rare. We now report a case in which a piece of
glass entered a girls heart from an injury to the right side
of her neck. Six months later, we successfully removed
the glass shard from the anterior wall of the right
ventricle.
(Ann Thorac Surg 2006;81:335 6)
2006 by The Society of Thoracic Surgeons
R ecently, we treated a patient who had a foreign body
in her heart. We removed a 4.5 cm dagger-shaped
glass shard from her heart 6 months after the injury. The
patient was wounded in the right side of her neck by
broken glass but had no chest injury.
A 6-year-old girl was sent to the emergency room for a
wound from a broken door in the right side of her neck.
At admission, the patient had serious bleeding, but
surgeons found nothing in the wound and sutured it
closed directly after disinfection and debridement.
The next morning, the patient had a pectoral pain and
dyspnea, and 5 days later she was referred to a local
childrens hospital. She had tachycardia and tachypnea
with shallow respiration. On physical examination, her
heart rate was 120 to 140 beats per minute, and her blood
pressure was 96/60 mm Hg. No heart murmur or peri-
cardial friction rub was heard, but heart sounds were
faint. Blood hemoglobin was 8.2 g/dL, and hematocrit
was 27%. Echocardiography showed cardiomegaly and a
mild pericardial effusion. Chest radiography showed a
mild right pleural effusion. Electrocardiography showed
nonspecific ST-segment and T-wave changes in lead II
and V2 to V5. A diagnosis of acute effusive pericarditis
and right pleurisy was made. During hospitalization, she
was kept in bed and received nasal oxygen, intravenous
coemzyme A, adenosine triphosphate, vitamin C, antibi-
otics, and antiviral medicines. She recovered after this
conservative management, and was discharged after 10
days.
After an uneventful 6 months, a small swelling with
tenderness developed on the right side of the patients
chest near the right edge of the sternum in the fourth
intercostal space. The lump developed very quickly
within a week and began to beat at the same rate as the
heart. She returned to our hospital. On physical exami-
nation, her heart rate was 96 beats per minute and blood
pressure 96/60 mm Hg. A scar was found on the right
Accepted for publication Oct 5, 2004.
Address correspondence to Dr Yang, Fu Wai Hospital, Bei Li Shi Lu 167,
Beijing 100037, China; e-mail: xiubinyang@yahoo.com.
2006 by The Society of Thoracic Surgeons
Published by Elsevier Inc
lateral neck, just over the external jugular vein (Fig 1).
The lump was conical, 1.5 cm in diameter, 1.2 cm high,
and located near the right edge of the sternum in the
fourth intercostal space. However, the volume and loca-
tion of the pulsatile mass changed slightly with the
heartbeat. A mild heart murmur was heard near the
xiphoid. Two-dimensional echocardiography showed
only mild tricuspid insufficiency. Chest radiography re-
vealed a foreign body located in the right heart and the
right anterior thorax. Nothing special was found by
electrocardiogram. Chest computed tomography identi-
fied a high-density, sliver-shaped foreign body in the
heart (Fig 2).
The patient was operated on through the sternotomy
during cardiopulmonary bypass. After pericardiotomy,
generalized adhesions were found, especially around the
foreign body, which entered the right ventricle. The
foreign body penetrated the right anterior surface of the
right ventricle and entered the right thoracic cavity. A
small skin incision was made just over the foreign body
FEATURE ARTICLES
in the right chest, and a piece of glass was extracted
under direct vision. The dagger-shaped glass shard was
4.5 cm long and 0.5 cm wide (Fig 3). The right ventricular
wound was repaired with a running 4-0 polypropylene
suture. There was no thrill palpable over the heart
postoperatively. The pericardium was left open. A drain-
age tube was placed in the pericardial space and also in
the right thoracic cavity. The patients postoperative
course was uneventful. Postoperative two-dimensional
echocardiogram revealed mild tricuspid regurgitation,
and no intracardiac shunt. The patient was discharged on
postoperative day 7 in very good condition.
Comment
The patients injury was strange. A large piece of glass
had entered her heart from a peripheral vein after an
accidental neck injury. Although the heart and right
thorax were penetrated on the second day after the
accident, the glass remained in the patients heart for
another half year. The glass nearly extracted itself from
the heart.
In reviewing the literature, we found nearly all post-
traumatic foreign bodies in the heart are metal objects,
and no glass has been previously reported. The diagnosis
is easily made for a metal foreign body by conventional
radiology and echocardiography [1]. But glass is non-
metal, and not so easily discovered by conventional
radiology. The patient had chest radiographs and two-
dimensional echocardiography several times during the
half-year interval, and no foreign body was found in any
examination. The piece of glass was embedded in myo-
cardium and surrounded by blood, pericardial fluid, and
pleural effusion on chest radiographs, and could only be
seen when the glass entered the thorax and after the
surrounding liquids had been absorbed completely. To
test the ability of echocardiography to detect glass, we
put a piece of glass into a pig liver, and demonstrated
0003-4975/06/$32.00
doi:10.1016/j.athoracsur.2004.10.007
 336 CASE REPORT MURUGAN ET AL
HEART SURGERY IN INFANTS WITH HEMOPHILIA
FEATURE ARTICLES
Fig 1. The scar of the neck. The arrow shows the location of the
scar.
that echocardiography could detect glass. The signal
intensity was similar to a rib. From this experience, we
speculate that computed tomography or magnetic reso-
nance imaging may be more accurate for the diagnosis of
nonmetal foreign bodies in the heart.
It was a miracle that the patient survived the glass
wound to her right ventricle and initially recovered after
10 days of conservative management. We deduce that
two factors helped the patient. First, the right ventricle
was a low-pressure chamber. Second, the glass pene-
Fig 2. Computed tomography image reveals a foreign body in the
right ventricle and right thorax.
2006 by The Society of Thoracic Surgeons
Published by Elsevier Inc
Ann Thorac Surg
2006;81:336 9
Fig 3. This dagger-shaped glass shard was removed from the heart.
trated the heart, pericardium, and the right pleura at the
same time, and intrapericardial fluid drained into the
right pleural cavity in time to prevent severe acute
cardiac tamponade.
Admitting our limited experience in treating chronic
cardiac foreign bodies, we chose to remove the glass by a
skin incision and repair the right ventricular wound
through sternotomy during cardiopulmonary bypass. We
found firm pericardial adhesions that allowed direct
removal of the glass shard through a separate skin
incision without producing acute pericardial temponade.
The authors thank Dr Weiguo Ma for reviewing the manuscript.
Reference
1. Actis Dato GM, Arslanian A, Marzio PD, Filosso PL, Ruffini E.
Posttraumatic and iatrogenic foreign bodies in the heart:
report of fourteen cases and review of the literature. J Thorac
Cardiovasc Surg 2003;126:408 14.
Heart Surgery in Infants With
Hemophilia
Subramanian Jothi Murugan, MRCP,
Sangeetha Viswanathan, MRCPCH,
John Thomson, MRCP, Jonathan M. Parsons, FRCP,
and Mike Richards, DM, MRCP
Departments of Pediatric Cardiology and Hematology, Leeds
General Infirmary, Leeds, United Kingdom
We describe 2 infants with hemophilia A who had heart
surgery under cardiopulmonary bypass with factor VIII
replacement therapy, and we recommend a guideline for
Accepted for publication Sept 1, 2004.
Address correspondence to Dr Murugan, Non-Invasive Unit, Department
of Pediatric Cardiology, E Floor, Jubilee Building, Leeds General Infir-
mary, Great George St, Leeds, LS1 3EX UK; e-mail: jothidevi1@
hotmail.com.
0003-4975/06/$32.00
doi:10.1016/j.athoracsur.2004.09.001