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Surgical removal of a bullet in the heart through a trans-mitral approach: a case report
Antonio Giovanni Cammardella1, Antonio Lio1, Leonardo De Luca2
1Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, via Gianicolense, 87, 00152 Rome, Italy.
Insights
Surgical removal of cardiac missiles (bullets, shrapnel) in asymptomatic patients is debated. This case demonstrates successful transatrial removal of a left ventricular missile, preserving mitral valve function.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
Background:
- Retained cardiac missiles, including bullets and shrapnel, pose management challenges.
- The surgical necessity for asymptomatic patients with cardiac missiles remains controversial.
Observation:
- A case of a retained missile within the left ventricle, near the posterior mitral leaflet, is presented.
- Surgical intervention was performed via a transatrial approach, involving detachment of the posterior mitral leaflet.
Findings:
- The patient experienced an uneventful postoperative recovery and was discharged on postoperative day seven.
- At 30-day follow-up, the patient exhibited good general condition and normal mitral valve function.
Implications:
- Individualized management is crucial for retained cardiac missiles.
- Preoperative imaging, such as echocardiography and CT scans, is essential for precise localization before surgical intervention.
Background:
Retained cardiac missiles have been considered bullets, shrapnel, or pellets included in the heart or the pericardial sac. In asymptomatic patients with retained cardiac missiles, the role of surgery is still debated.
Case Summary:
We describe the case of successful surgical treatment of a retained missile localized within the left ventricle in close proximity of the posterior mitral leaflet. The operation was performed through a transatrial approach, detaching the posterior mitral leaflet. The post-operative course was uneventful. The patient was discharged on the seventh post-operative day. At 30-day follow-up visit, the patient was in good conditions, with normal mitral valve function.
Discussion:
The management of retained cardiac missiles should be individualized. If a decision is made to operate, multiple imaging techniques including echocardiography and computed tomography scan are mandatory to precisely locate the bullet.
