Trajectory Matters: A Case of Bullet Extraction From the Heart via a Median Sternotomy

A 37-year-old man presented with a gunshot wound to the left chest. Initial evaluation revealed no exit wound, and a left anterolateral thoracotomy was performed, revealing a right ventricular injury. A transesophageal echocardiogram (TEE) identified the bullet lodged in the right ventricle near the septal leaflet of the tricuspid valve. Given the bullet's trajectory, a median sternotomy was performed for the removal of the bullet and the repair of the ventricular septal defect. The patient made a full recovery postoperatively. This case highlights the critical role of anticipating and understanding bullet trajectory in guiding surgical decision-making and optimizing patient outcomes.