ARTILLERY SHELL FRAGMENTS IN THE HEART: DIAGNOSIS AND MANAGEMENT

Delayed evaluation and management of penetrating cardiac injuries especially mortar fragments were performed in 30 war victims in the Shahid Rajai Heart Hospital, Tehran. All were men with a mean age of 20.7 years. Pleuritic chest pain was the most common symptom (53.3%), while physical examination was negative in the majority of cases (66.8%). 50 percent of the cases had pericardial effusion on the echocardiogram. The right ventricle was the most frequent site of involvement (26.6%) followed by the left ventricle (16.6% ), right atrium, left atrium, aorta (each 13.3%), pulmonary trunk (10%), and inferior surface of the heart (6.6%). More than half of the cases had associated hemothorax. Shell fragments were removed in all cases but two. Fragments larger than one centimeter in the vicinity of the heart structures in the pericardium are recommended to be removed.