Document Type : Case Report
Authors
1 Cardiovascular Research Center, Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pediatrics, Ali-Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
3 ShahidBeheshti University of Medical sciences, Tehran, Iran
Abstract
There have been very rare reports on the migration of foreign bodies that are left or implanted in the body, and so far, they have only been reported in the gastrointestinal tract and intestines (a process similar to phagocytosis), later manifesting as an obstruction in the lumen. Meanwhile, no such cases have yet been reported in the cardiovascular system.
The case reported here is a 14-month-old girl who had undergone pulmonary artery banding (PA band made of PTFE) around the pulmonary artery at the age of 8 months due to severe pulmonary hypertension and failure to thrive. She underwent reoperation six months later for a final treatment. It was discovered that the PA band was no longer around the pulmonary artery and had migrated completely into the pulmonary artery while remaining intact and circular and was drawn into the pulmonary artery in a process similar to phagocytosis. The PA band was removed completely. The uneven surface inside the main pulmonary artery was resected and the artery was repaired end-to-end. A total heart repair surgery was again performed on the patient. No problem was observed in the 2.5-year follow-up after the second surgery.
Overall, the authors’ case is the first instance of migration of a biologically-neutral foreign body into the cardiovascular system that had occurred six months after the PA-band implantation, and the first case of erosion of a foreign body into the lumen outside the gastrointestinal tract. Although the authors could not find the cause of the presented case, reports on future cases can help find the underlying reason
There have been very rare reports on the migration of foreign bodies that are left or implanted in the body, and so far, they have only been reported in the gastrointestinal tract and intestines (a process similar to phagocytosis), later manifesting as an obstruction in the lumen. Meanwhile, no such cases have yet been reported in the cardiovascular system.
The case reported here is a 14-month-old girl who had undergone pulmonary artery banding (PA band made of PTFE) around the pulmonary artery at the age of 8 months due to severe pulmonary hypertension and failure to thrive. She underwent reoperation six months later for a final treatment. It was discovered that the PA band was no longer around the pulmonary artery and had migrated completely into the pulmonary artery while remaining intact and circular and was drawn into the pulmonary artery in a process similar to phagocytosis. The PA band was removed completely. The uneven surface inside the main pulmonary artery was resected and the artery was repaired end-to-end. A total heart repair surgery was again performed on the patient. No problem was observed in the 2.5-year follow-up after the second surgery.
Overall, the authors’ case is the first instance of migration of a biologically-neutral foreign body into the cardiovascular system that had occurred six months after the PA-band implantation, and the first case of erosion of a foreign body into the lumen outside the gastrointestinal tract. Although the authors could not find the cause of the presented case, reports on future cases can help find the underlying reason
Keywords
2. Alemu BN, Tiruneh AG. Gossypiboma: a case series and literature review. Ethiop J Health Sci 2020; 30(1).https://doi.org/10.4314/ejhs.v30i1.19
3. Retnamma RK, Nair SG, Umadethan B, Manoj P. An unusual case of thoracic gossypiboma. Ann Card Anaesth 2010; 13(3): 261. https://doi.org/10.4103/0971-9784.69059
4. Srivastava K, Agarwal A. Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature. Case Rep Surg 2014; 2014. https://doi.org/10.1155/2014/713428
5. Kim DK, Hwang SK, Lee SC, Lee YJ, Jung JP, Park CR, et al. A 31-year-old pericardial textiloma. Cardiovasc J Afr 2020; 31(2): e5-e8. https://doi.org/10.5830/CVJA-2019-068
6. Sologashvili T, Kalangos A, Tissot-Daguette C, Myers PO, editors. Incidental gossypiboma discovered during tricuspid valve re-repair 11 years after Ebstein anomaly repair. Heart Surg Forum 2013. https://doi.org/10.1532/HSF98.20131015
7. Suliman H, Blickman J, Amrane A. Chest gossypiboma after coronary surgery. 2007.
8. Shahreza FD. From oxidative stress to endothelial cell dysfunction. J Prev Epidemiol. 2016; 1(1): e04-e.
9. Pujahari A. Gossypiboma: Three cases. Trop Gastroenterol 2010; 31(3): 217-8.
10. Dhillon JS, Park A. Transmural migration of a retained laparotomy sponge. Am Surg 2002; 68(7): 603.https://doi.org/10.1177/000313480206800709
11. Yildirim S, Tarim A, Nursal TZ, Yildirim T, Caliskan K, Torer N, et al. Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg 2006; 391(4): 390-5. https://doi.org/10.1007/s00423-005-0581-4
12. Ahmad G, Attiq-ur-Rehman S, Anjum MZ. Retained sponge after abdominal surgery. J Coll Physicians Surg Pak 2003; 13(11): 640-3.
13. Andronic D, Lupaşcu C, Târcoveanu E, Georgescu S. Gossypiboma-retained textile foreign body. Chirurgia (Bucur) 2010; 105(6): 767-77.