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Surviving shot through the heart: Management in two cases
Insights
Gunshot penetrating cardiac injuries are challenging. This study details managing two cases of traversing bullet heart injuries, one requiring cardiopulmonary bypass for ventricular septal defect repair and the other managed without it.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Ballistics Trauma
Background:
- Penetrating cardiac injuries from gunshots are often fatal and complex to manage, even in well-equipped facilities.
- Such injuries can lead to ventricular septal defects (VSD) or cardiac tamponade, influenced by bullet trajectory and velocity.
- Patient stability dictates the immediate management strategy: diagnostic imaging for stable patients versus urgent surgery for unstable ones.
Abstract:
Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully- equipped centres. Such injuries can cause ventricular septal defect (VSD) or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography (CT) to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass (CPB) along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart.