Removal of a Bullet from the Septum after a Cardiac Gunshot

Abstract

Most gunshot wounds to the heart are rapidly lethal because of cardiac tamponade or exsanguinations. The immediate clinical manifestations or cause of death from a retained missile are usually related to cardiac bleeding with or without tamponade. The intermediate manifestations of cardiac injury include myocardial infarction with cardiogenic shock, and bullet embolus to a peripheral artery. Late complications include missile erosion through the myocardium, endocarditis, pseudoaneurysm, ventricular septal defect, and valvular damage. A removal of bullet from the heart using cardiopulmonary bypass might be necessary to avoid possible complications. Use of CPB for these injuries allows for extensive rotation and retraction of the heart in a bloodless and motionless operative field.