Penetrating Chest Trauma with Iron Rod In-situ: A Surgical Challenge

Introduction: Chest trauma both blunt and penetratingconstitutes 10-15% of all traumas and 25% of all deaths fromtraumatic injuries.Case report: We present a case of penetrating right chesttrauma following road traffic accident (RTA) with big metallicrod in-situ, entering from right axillary region and coming outfrom posterior chest wall. The force of impact was so severethat the heavy iron rod got bent upon itself making its removala surgical challenge.Conclusion: In cases of penetrating chest trauma earlyassessment, accurate diagnosis, and rapid transport with noattempt to remove the penetrating foreign body and meticulousplanning play key role in its successful management.

Percutaneous ASD Closure Requiring Emergency Surgical Removal of Embolized Cardiac Occluder Devices

Introduction: Atrial septal defect (ASD), ventricular septaldefect (VSD), patent ductus arteriosus (PDA) are mostcommon congenital acyanotic heart diseases. Surgery isthe gold standard treatment for these defects. Percutaneousdevice closure is now getting popular for closure of thesedefects (Ostium Secundum ASD, PDA, muscular VSD).Device dislodgement, migration and embolization is a causeof failure in this procedure. For this emergency surgicalretrieval of migrated device becomes necessary at times.Here two different scenarios of failed device closure of ASDare presented who required emergency surgical retrieval ofdevice.Case report: In the first case the device got embolized intothe main pulmonary artery which was retrieved surgicallyand his post-operative period was uneventful. In the secondcase the device got embolized into right ventricle. Surgicallythe device was retrieved but post operatively the patient wasfound to have CVA from which she recovered gradually anddischarged.Conclusion: Proper assessment of defect size and rim aroundthe defect is necessary. Devices of all sizes should be availablewith the team doing the procedure. During implantation incase of unsatisfactory device position it should be retrievedand elective surgical closure should be planned. Surgeonsshould be kept in backup in all catheter based procedure.