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Transfemoral extraction of an intracardiac bullet embolus
1Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia 30310-1495, USA.
Insights
This study presents a transfemoral technique for removing intracardiac missiles, offering a less invasive alternative to thoracotomy for stable patients with gunshot wounds.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Interventional Cardiology
Background:
- Intracardiac missiles pose significant surgical challenges, requiring careful consideration of patient stability and injury severity.
- Traditional missile retrieval often involves thoracotomy, a procedure associated with substantial morbidity.
- Understanding missile trajectories (direct thoracic penetration or venous circulation) is crucial for surgical planning.
Observation:
- A case report details a 40-year-old male patient with an intracardiac missile following a gunshot wound to the right gluteal region.
- The patient's hemodynamic stability allowed for a less invasive approach.
- Diagnostic imaging confirmed the missile's intracardiac location.
Findings:
- A transfemoral technique was successfully employed to retrieve the intracardiac projectile.
- This minimally invasive approach avoided the need for thoracotomy.
- The procedure was performed in a hemodynamically stable patient.
Implications:
- The transfemoral approach offers a viable alternative for intracardiac missile extraction in select stable patients.
- This technique may reduce surgical trauma and recovery time compared to open thoracotomy.
- Further research should explore the broader applicability and long-term outcomes of this method in trauma care.
Abstract:
Missiles may reach the heart via direct penetration of the thoracic cavity or indirectly by means of the venous circulation. Often the hemodynamic stability of the patient dictates the approach that is used not only to retrieve the projectile but also to repair associated life-threatening injuries. The case of a 40-year-old man with an intracardiac missile after a gunshot wound to the right gluteal area is presented along with the transfemoral technique used to recover an intracardiac projectile. This approach may be used instead of thoracotomy for missile extraction in stable patients.