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(Circulation. 2007;115:e467-e468.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

A Magic Bullet Through the Heart

Numan Ali Aydemir, MD; Ihsan Bakir, MD; Firat Altin, MD; Sinan Sahin, MD; Mehmet Salih Bilal, MD

From Siyami Ersek Thoracic and Cardiovascular Surgery Center, Tibbiye Caddesi Haydarpasa, Istanbul, Turkey.

Correspondence to Dr Numan Ali Aydemir, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiovascular Surgery Tibbiye Caddesi Haydarpasa, Kadikoy, 34000 Istanbul-Turkey. E-mail numan.aydemir{at}isbank.net.tr

Penetrating cardiac trauma caused by gunshot constitutes the most fatal form of cardiothoracic injury because of its potential mortality. The heart lesions encountered in such situations are different and are sometimes surprising.^1,2

We report a 16-year-old boy whom a relative accidentally shot at close range while trying to fieldstrip the handgun. The pistol, originally a replica manufactured to fire blank cartridges, was illegally converted by a gunsmith to fire live ammunition. In this case, the high-velocity projectile was a 6-mm brass pellet; it entered the right anterior thoracal cavity approximately 3 cm above the nipple. A noncontrast scan was performed and showed a linear cloud of density in the whole chest, marking the passage of the bullet (Figures 1 and 2).

View larger version (122K): [in this window] [in a new window]   Figure 1. Axial computed tomography scan of the chest and the heart, showing passage of the bullet through both lungs. The bullet resides between the eighth and ninth ribs.

View larger version (87K): [in this window] [in a new window]   Figure 2. Transverse computed tomographic scan of the chest and the heart, showing passage of the bullet through both lungs. The bullet resides between the eighth and ninth ribs.

The patient was put on urgent extracorporeal circulation. The exploration of the surgical field revealed that, after passing through the right lung, the pellet penetrated the right atrium, pierced through the atrial septum, punctured a hole near the posterior leaflet of the mitral annulus, and exited the heart on the left ventricle just near the circumflex artery close to the atrioventricular groove. The pellet then passed through the left lung and ended up between the eighth and ninth ribs. The surgical procedure consisted of cardiac and thoracal entry, and the exit wounds were sutured primarily by prolene sutures supported with Teflon pledgets. Fortunately, the patient did well after surgery and was discharged from the hospital 10 days after treatment. The control echocardiography after 6 months revealed no myocardial abnormalities, no pericardial effusion, and no valve-related problems (Movies I and II). The ECG was unremarkable, with no signs of ischemic or conduction pathologies.

It is important to carefully follow up with patients after gunfire to the heart, because further changes in the valves and related structures are possible.¹

	Disclosures

Top Disclosures References

 
None.

	Footnotes

 
The online-only Data Supplement, consisting of movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/20/e467/DC1.

	References

Top Disclosures References

 

1. Aubert S, Neto OS, Pawale A, Dreyfus GD. Late mitral valve regurgitation after bullet wound to the heart. Ann Thorac Surg. 2006; 82: 737–739.[Abstract/Free Full Text]
   
2. Wainsztein N, Mautner B. A bullet in the heart. Circulation. 1999; 100: 1361.[Free Full Text]
   

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Circulation 2007 115: 2591. [Full Text]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aydemir, N. A. Articles by Bilal, M. S. Search for Related Content PubMed PubMed Citation Articles by Aydemir, N. A. Articles by Bilal, M. S. Related Collections CV surgery: other Computerized tomography and Magnetic Resonance Imaging Other imaging Related Article