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Right ventricular bullet embolectomy without cardiopulmonary bypass
Insights
A bullet lodged in the heart was removed via right ventriculotomy. This surgical approach avoided cardiopulmonary bypass, preventing further bullet migration in this gunshot wound case.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Radiology
Background:
- Gunshot wounds to the chest require differentiation between direct cardiac penetration, cardiac bullet emboli, and missile proximity.
- Radiographic evidence of bullets near the heart necessitates prompt and accurate diagnosis.
Observation:
- An unusual case of a bullet embolus to the heart is presented.
- Initial thoracotomy was performed to exclude direct cardiac penetration.
- An intracardiac bullet was unexpectedly palpated within the right ventricle apex during surgery.
Findings:
- A bullet was successfully removed from the right ventricle apex via ventriculotomy.
- The embolectomy was performed without cardiopulmonary bypass.
- This technique prevented potential retrograde or distal bullet migration.
Implications:
- Right ventriculotomy without cardiopulmonary bypass is a viable option for intracardiac bullet emboli removal.
- This approach minimizes risks associated with cardiopulmonary bypass in specific trauma scenarios.
- Accurate differentiation and timely intervention are crucial for managing cardiac bullet emboli.
Abstract:
Victims of gunshot wounds may be noted to have bullets overlying the cardiac silhouette on roentgenogram. Direct cardiac penetration, bullet embolus to the heart, and missile proximity to the heart are all possibilities which must be differentiated. An unusual case of bullet embolism is presented in which thoracotomy was initially performed to rule out direct cardiac penetration. At the time of exploration, an intracardiac bullet embolus was fortuitously palpated and trapped within the apex of the right ventricle. Right ventriculotomy and embolectomy without cardiopulmonary bypass were performed to prevent retrograde or distal migration.