Right ventricular bullet embolectomy without cardiopulmonary bypass

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.