Asymptomatic gunshot wound to the heart with retained intracardiac pellet

A 20-year-old man was transferred to our institution with multiple penetrating thoracoabdominal wounds from a shotgun. Imaging revealed several retained shotgun pellets, 1 of which appeared to be located in the left atrium. He was asymptomatic from a cardiac standpoint and was first taken to the operating room to manage his multiple abdominal injuries. Neither an intraoperative echocardiogram nor a formal postoperative echocardiogram definitively determined pellet location (myocardium versus chamber). Because of concerns for pellet embolus from left atrial positioning, the patient was returned to the operating room. After placing the patient on cardiopulmonary bypass, the pellet was identified within the wall of the left atrium and was successfully removed without complication.