Abordagem terapêutica dos projéteis retidos no coração

Abstract

A 29-year-old man, having a firearm wound, with a missile lodged in the heart. He arrived at the hospital in hemodynamic stable condition. The transesophageal echocardiogram (TE) effectuated on the diagnosis and reveled on the missile location. After 18 days, he underwent an elective off-pump cardiac surgery for extract of a bullet from the right ventricle (RV) wall and interventricular septum (IVS), having an uneventful postoperative evolution. The authors discuss the therapeutic options to follow, based on data of related literature, concluding that some individualized asymptomatic patients with a missile embedded in the heart should undergo surgery to remove it. Resumo Paciente do sexo masculino, 29 anos, apresentando ferimento por arma de fogo, com projétil alojado no coração e que chegou ao hospital hemodinamicamente estável. O diagnóstico, evidenciando a localização da bala, foi feito pelo ecocardiograma transesofágico (ET). Após 18 dias, foi submetido à cirurgia eletiva, sem circulação extracorpórea (CEC), para retirada do projétil encravado em parede anterior do ventrículo direito (VD) e septo interventricular (SIV), com sucesso. Os autores discutem a conduta terapêutica para os projéteis retidos no coração, com base na literatura consultada, concluindo que a cirurgia para remoção dos mesmos pode ser indicada em pacientes assintomáticos individualizados. Descritores: Ferimentos por arma de fogo, cirurgia. Corpos estranhos, cirurgia. Traumatismos cardíacos. Septo cardíaco, lesão, cirurgia. Ventrículos cardíacos, lesão, cirurgia. Abordagem terapêutica dos projéteis retidos no coraçãoManagement of bullets lodged in the heart

Heart Injury with Projectile Lodged Inside the Heart

“…Similar to this report, is Meira et al. [ 6 ] report case, in which the projectile lodged inside the right ventricle was removed 18 days after the trauma. In this particular case, the projectile was also lodged inside the right ventricle, but 65 days were elapsed between the lesion and its removal.…”

“…In this particular case, the projectile was also lodged inside the right ventricle, but 65 days were elapsed between the lesion and its removal. Ventricular penetrating lesions tend to bleed less intensely than atrial ones because they are stagnant during myocardial contractions [ 2 , 6 ] , a fact that may have been relevant to the favorable outcome presented here. In this way, another relevant point may have been the location near the apex of the right ventricle, a trabecular region, which may have contributed to the containment of the bleeding.…”

Ferimento cardíaco transfixante por projétil de arma de fogo: relato de caso

“…Injuries caused by knives are more frequent than by firearms when it comes to penetrating cardiac injuries, however, the increase in rates of urban violence has contributed to the growing importance of these injuries by firearms [4][5][6][7][8][9]. In a retrospective study conducted by Rodrigues et al [5], out of the 70 patients with penetrating cardiac injuries in the study, 43 (61.4%) presented injuries from knives and 27 (38.6%) by firearms, and respective mortality rates of 52.2% and 47.8%, with no statistically significant differences in mortality between the two groups of patients.…”

“…The authors explain that the ventricular penetrating injuries tend to bleed less intensely than the atrial ones, due to being stagnant during myocardial contractions, which may have been relevant to the outcome presented by our patient, as well as by a patient reported by Meira et al . [9], where the bullet lodged in the RV was removed 18 days after the trauma.…”