Transcardiac Bullet Embolus to the Pulmonary Vein

Abstract

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Approach to Management of Intravascular Missile Emboli: Review of the Literature and Case Report

“…The authors stated that the use of 2D echocardiogram intraoperatively may have led to finding the bullet in the left atrium before it migrated in a retrograde fashion to the right pulmonary vein. 13 , 14 TEE intraoperatively is the modality of choice for confirming intracardiac missile emboli, with TEE preferred to transthoracic echocardiogram since TEE helps better visualize the level of myocardial damage. 15 In addition, echocardiogram sometimes demonstrates how deeply embedded the foreign body is, further affecting medical decision making.…”

“…As mentioned earlier, Schulman et al reported one case in which a right pulmonary vein embolus caused fatal outflow obstruction between the right lung and left heart. 13 While most emboli to the left heart presumably originate from the pulmonary veins, and some left-heart missiles may be managed conservatively, missile emboli retained in the pulmonary veins are dangerous. Though future case reports may give us better understanding of this phenomenon, as it stands now, all missile emboli in the pulmonary veins likely require removal ( Figure 5 ).…”