Shot through the heart: survivorship of gunshot wound

Abstract

Introduction: While penetrating cardiac injuries are rare in incidence, its poor management carries grave prognosis. Prompt prehospital care and timely intervention are vital to ensure the victim’s survival. This report explores a case of an air rifle injury through the heart with satisfactory outcomes through meticulous preoperative planning and surgical intervention.

Case: A 21-year-old man suffered an air rifle gunshot wound due to an occupational accident. The patient presented with stable hemodynamics. Chest X-ray revealed a right hemothorax with a bullet-like material in the mediastinum. Consecutive transthoracic echo workup suggested a foreign body material at the right ventricular septal wall with mild pericardial effusion. A thoracic CT scan revealed an intracardiac metallic material. The patient underwent an urgent open-heart surgery to evacuate the bullet with the use of a cardiopulmonary bypass machine, found at the posterior right ventricular wall on exploration. No lung laceration from the trajectory track through the right side was found. The patient was hospitalized for a total of 10 days before discharged under good condition. A median sternotomy was initiated with aortic, superior vena cava (SVC), and inferior vena cava (IVC) cannulation. Upon exploration, the bullet track originates from the right mediastinal pleura through the right atrium (RA), nestled in the right ventricle (RV). Approach via the RA through the tricuspid valve (TV) revealed a 3 x 3 x 5 mm airgun pellet at the posterior wall of the RV. No lung laceration was identified. A chest drain was inserted, and the patient was discharged under good condition.

Conclusion: Although rare, surviving a cardiac gunshot wound is possible with rapid response, immediate intervention, and comprehensive postoperative care. This case exemplifies the critical role of trauma response team and the need for ongoing research to refine treatment protocols.