{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T02:10:05Z","timestamp":1758334205559,"version":"3.44.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Traumatic penetrating cardiac injuries are usually immediately fatal. The management approach (surgical vs. conservative) in surviving patients can be challenging. A conservative approach is appropriate in selective cases; however, long-term complications should be considered.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A frail 83-year-old male who had undergone coronary artery bypass grafting surgery 20 years ago presented with encephalopathy. He had persistent bacteraemia. Chest computed tomography revealed three metal nails penetrating the anterior thoracic wall through the myocardium. Later, we learned that he had attempted suicide 2 years ago by shooting himself in the chest using a nail gun. Conservative non-surgical approach was pursued at that time given his multiple comorbidities. We adopted a conservative approach again. He survived for additional 6 months on chronic suppressive antimicrobial therapy but ultimately passed away from pneumonia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The favourable outcome in this patient underscores the role of a conservative approach in selective cases. Retained foreign bodies pose a risk of infective endocarditis; therefore, empirical chronic antimicrobial therapy and tetanus vaccination should be considered.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf380","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T11:24:34Z","timestamp":1754911474000},"source":"Crossref","is-referenced-by-count":0,"title":["Conservative non-surgical management of penetrating cardiac injury with three retained metal nails: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1707-0414","authenticated-orcid":false,"given":"Ramtin","family":"Khanipour","sequence":"first","affiliation":[{"name":"Division of Cardiology, HCA Healthcare\u2014HCA Florida Bayonet Point\/USF Morsani College of Medicine , 14000 Fivay Rd, Hudson, FL 34667 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saro","family":"Mazmanian","sequence":"additional","affiliation":[{"name":"Division of Cardiology, HCA Healthcare\u2014HCA Florida Bayonet Point\/USF Morsani College of Medicine , 14000 Fivay Rd, Hudson, FL 34667 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, HCA Healthcare\u2014HCA Florida Bayonet Point\/USF Morsani College of Medicine , 14000 Fivay Rd, Hudson, FL 34667 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Dahhan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, HCA Healthcare\u2014HCA Florida Bayonet Point\/USF Morsani College of Medicine , 14000 Fivay Rd, Hudson, FL 34667 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"2025091917325441300_ytaf380-B1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1136\/jramc-155-03-02","article-title":"Penetrating cardiac injury","volume":"155","author":"O'Connor","year":"2009","journal-title":"J R Army Med Corps"},{"key":"2025091917325441300_ytaf380-B2","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1007\/s00068-024-02556-1","article-title":"Surgical management of chest injuries in patients with multiple and\/or severe trauma- a systematic review and clinical practice guideline update","volume":"50","author":"Schreyer","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025091917325441300_ytaf380-B3","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S0022-5223(03)00399-4","article-title":"Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature","volume":"126","author":"Actis Dato","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025091917325441300_ytaf380-B4","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S0020-1383(01)00068-7","article-title":"Penetrating cardiac injuries: a complex challenge","volume":"32","author":"Asensio","year":"2001","journal-title":"Injury"},{"key":"2025091917325441300_ytaf380-B5","doi-asserted-by":"crossref","first-page":"E580","DOI":"10.1503\/cjs.008521","article-title":"Technical considerations in the management of penetrating cardiac injury","volume":"65","author":"Ball","year":"2022","journal-title":"Can J Surg"},{"key":"2025091917325441300_ytaf380-B6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/med-22-18","article-title":"Penetrating cardiac injury: a narrative review","volume":"7","author":"Hromalik","year":"2023","journal-title":"Mediastinum"},{"key":"2025091917325441300_ytaf380-B7","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1177\/00031348241307400","article-title":"Cardiac trauma: a review of penetrating and blunt cardiac injuries","volume":"91","author":"Lee","year":"2025","journal-title":"Am Surg"},{"key":"2025091917325441300_ytaf380-B8","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1148\/radiology.170.3.2644664","article-title":"Split 24-F Amplatz dilator for percutaneous extraction of an intravascular bullet: case report and technical note","volume":"170","author":"Gaylord","year":"1989","journal-title":"Radiology"},{"key":"2025091917325441300_ytaf380-B9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00246-017-1689-3","article-title":"Percutaneous removal of intravascular pellet following penetrating cardiac trauma","volume":"39","author":"Chew","year":"2018","journal-title":"Pediatr Cardiol"},{"key":"2025091917325441300_ytaf380-B10","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/01.JTN.0000337154.16088.6d","article-title":"Right ventricular gunshot wound with retrograde embolization","volume":"15","author":"McLaughlin","year":"2008","journal-title":"J Trauma Nurs"}],"container-title":["European Heart Journal - 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