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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@isbank.net.tr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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):   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):   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 . . . [Full Text of this Article]

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Circulation 2007 115: 2591. [Extract] [Full Text]

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				G. Goliasch, F. Wiesbauer, H. Pesau, and T. Binder A journey straight through the heart: the story of a bullet Eur J Echocardiogr, June 1, 2009; 10(4): 596 - 598. [Abstract] [Full Text] [PDF]