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Missiles in the heart.

P N Symbas1, S E Vlasis-Hale, A L Picone

  • 1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.

The Annals of Thoracic Surgery
|August 1, 1989
PubMed
Summary
This summary is machine-generated.

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Retained cardiac missiles, especially small caliber bullets, can be managed individually. Many patients with bullets left in the heart tolerate them well without cardiac symptoms.

Area of Science:

  • Cardiology
  • Trauma Surgery
  • Forensic Pathology

Background:

  • Missile injuries to the heart are rare but serious events.
  • Management strategies for retained cardiac missiles have evolved over time.

Purpose of the Study:

  • To review the management and outcomes of patients with missiles retained in the heart.
  • To determine the safety and efficacy of different treatment approaches.

Main Methods:

  • Retrospective review of 24 patients treated between 1968 and 1987.
  • Analysis of patient records, including injury mechanisms, clinical presentation, diagnostic methods, and surgical interventions.

Main Results:

  • Most missiles lodged directly in the heart (22/24).

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  • Initial presentations varied, including cardiac tamponade, hemothorax, and shock.
  • Surgical intervention (emergency or elective) was performed in 15 patients, with successful removal in 10.
  • 14 patients had missiles left in situ, with no cardiac symptoms reported during follow-up (up to 15 years).

    • Conclusions:

    • Individualized management based on clinical course and missile location is crucial.
    • Small caliber bullets (.38 or smaller) retained in the heart can be well-tolerated in select cases.
    • Conservative management with observation may be a viable option for asymptomatic patients.