Asian Cardiovasc Thorac Ann 2006;14:443-444
© 2006 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Shot Through the Heart
Omer Ashraf, MBBS,
Syed Shahabuddin, MBBS1,
Ghufranullah Khan, FCPS1,
Hasanat Sharif, FRCS1
Medical College, Aga Khan University
1 Department of Surgery, Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
For reprint information contact: Hasanat Sharif, FRCS Tel: 92 21 486 4713 Fax: 92 21 493 4294 Email: hasanatsharif2{at}yahoo.com, Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
A 35 years old gentleman presented with a bullet entrance wound on the anterior chest wall, with no exit wound. Chest radiography established a metallic density, conforming to appearance of a bullet, projected over the cardiac silhouette (Figure 1
).
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Figure 1. Metallic density, conforming to appearance of a bullet is noted projected over the cardiac silhouette on frontal chest radiograph.
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Computed tomography scanning revealed the bullet to be lying behind the heart, close to the descending aorta (Figure 2). Median sternotomy under cardiopulmonary bypass was undertaken and bullet retrieved and clot removed from behind the left ventricle. The entry and exit wounds were visualized on the ventral (right ventricle) and dorsal (left ventricle) surfaces of the heart respectively, and successfully repaired along with the ventricular septal defect. The patient tolerated the procedure well and underwent a complete recovery in the post-operative period with no residual cardiac deficit at follow-up visits.
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Figure 2: Metallic density noted just posterior to and inseparable from posterior wall of left ventricle; mild pericardial effusion, along with bilateral pleural effusion, plus basal pulmonary atelectasis is also present.
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Penetrating injury to the heart is one of the severest forms of trauma, generally fatal with seldom survival. This is the first report of a gunshot injury survival in which the bullet has completely traversed the heart.
