Bullet in the interventricular septum: report of surgical removal in two cases

We have had the opportunity of treating two patients who were wounded by gunshot bullets lodged in the interventricular septum (IVS). The first patient was treated by suture of the ventricle in another hospital. He was then directed to our institution where cineangiocardiography and echocardiogram revealed a bullet in the IVS close to the outlet of the left ventricle. The bullet was removed using cardiopulmonary bypass (CPB), through an incision in the right side of the septum. The patient's recovery was satisfactory, and he was asymptomatic in the 18th postoperative month. In January 25th, 1987 we attended another patient hit by a firearm bullet. The X-Ray revealed a bullet in the cardiac area. The patient was submitted to a median sternotomy and an intraoperative echocardiogram was carried out, which showed that the bullet was located in the interventricular septum. With CPB the right atrium was opened up and the bullet was removed from the interventricular septum. The patient's evolution was also satisfactory. These reports demonstrate the importance of complete evaluation of patients with thoracic wounds and the feasibility of diagnosis and surgical removal of bullets from the interventricular septum.