Bullet Fragment Venous Embolus to the Heart

Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

“…Arterial embolization occurred mostly in the lower extremities, more commonly the left side than the right [ 8 ]. Venous embolism was associated with primary injuries of the following veins: external iliac vein [ 8 , 26 , 27 ], inferior vena cava [ 9 , 10 ], portal vein [ 28 ], renal vein [ 16 ], femoral vein [ 7 ], right ventricle of the heart [ 11 ], cranial venous sinus [ 6 , 29 – 32 ], subclavian vein [ 33 ], and neck veins [ 9 , 34 ].…”

Conservative Management of Retained Cardiac Missiles: Case Report and Literature Review

“…25 Elective retrieval for missiles traversing a contaminated organ has also been advocated to prevent septic complications. 6,8,26,43 Irregular missiles such as high-velocity nails and saw-blade fragments (even chicken wire struck by a lawn mower has been reported) should be removed to prevent myocardial damage that can be produced by their shape. 19,21,25,26,34,38,39,41 Wandering intracavitary missiles are apparent on serial imaging and should also be removed to prevent distal embolization of a main pulmonary artery or systemic artery.…”

“…Cardiopulmonary bypass with arteriotomy and extraction was successfully employed. Less inva- Tamponade/significant pericardial effusions Entry into heart after contamination 6,8,26,45 Irregular missile (nail, chicken wire, saw blade fragment) 19,21,25,26,34,36,38,39,45 Wandering intracardiac missile on serial imaging 3,13,23,31,80 Intracardiac shunt 27,65 Posttraumatic dysrhythmia 35, 55,66 Hemodynamically significant valvular abnormality 7,78,80 Left heart location 1 Proximity to vital structure (major coronary artery/vein or conduction system) with concern for future complication 49 Pericardial location: based on historical literature with high complication rate and eases of retrieval 1,88 Postinjury fevers with concern for missile providing source for sepsis 3,27,33 Intraoperatively during mediastinal exploration for other indication in setting of accurate localization and minimal expected difficulty in retrieval Inability to establish long term follow up for serial examination/imaging sive, endovascular techniques for the management of RCM have also been described. Controlled embolization from the right ventricle into the lower extremity venous system that uses rapid fluoroscopic table repositioning has been successful in 2 cases.…”

“…Intracavitary and intramyocardial retained missiles can be retrieved using offpump cardiac surgery. 6,14,18,19,28,29 Fedalen 29 has reported successful off-pump missile retrieval using the assistance of a heart stabilization device. More complex injuries with retained cardiac missiles require cardiopulmonary bypass for repair.…”

Bullet Embolus to the Heart after Gunshot Wound to the Neck: A Case Report

“…These emboli should be removed to prevent complications, which include bacterial endo-carditis, myocardial irritability, valvular dysfunction, erosion of the bullet through cardiac tissue, embolization to the pulmonary vasculature resulting in infarction and abscess formation, thrombosis, septicemia, and "cardiac neurosis." 2,3,6,7 Percutaneous relocation and missile extraction via the transjugular 1 and transfemoral 2 approaches have been described. Removal via thoracotomy or median sternotomy has also been described.…”