Journal of Indonesia Vascular Access

Shot through the heart: survivorship of gunshot wound

Amy Rosalie Sukamto — 2026-05-16

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.

Minimally invasive concomitant aortic and mitral valve surgery in systemic lupus erythematosus patients: a step ahead of our learning curve, challenges, and outcomes

Wirya Ayu Graha — 2026-05-16

Introduction: Minimally invasive cardiac surgery (MICS) has emerged as a promising approach for treating valve disorders, offering reduced surgical trauma and faster recovery.

Case illustration: This case report details MICS in concomitant aortic and mitral valve surgery in a 37-year-old female patient presenting with severe aortic regurgitation (AR) and moderate mitral regurgitation (MR), complicated by systemic lupus erythematosus (SLE). The patient underwent minimally invasive double valve surgery involving aortic valve replacement and mitral valve repair. Despite careful preoperative planning and intraoperative transesophageal echocardiography (TEE) confirmation, postoperative challenges arose, including left leg weakness attributable to SLE-associated neuropathy. This report highlights the procedural nuances, pitfalls encountered, and how the surgical team navigated the steep learning curve associated with adopting the operative technique. Outcome evaluation revealed satisfactory mechanical valve function with no paravalvular leakage or residual MR. However, the case underscores the importance of anticipating complications, particularly in patients with complex comorbidities.

Conclusion: This report contributes to the growing body of literature on MICS, emphasizing the need for continuous refinement of techniques and a multidisciplinary approach to optimize patient outcomes.

Right ventricle myxoma with massive pericardial effusion: a case report

Alif Alfian Akbar — 2026-05-20

Introduction: Right ventricular myxomas (RVM) are exceedingly rare primary cardiac tumors, comprising less than 5% of all cardiac myxomas. The challenge of establishing diagnosis and proper management might improve survival in such patients.

Case illustration: A 53-year-old female presented with a primary complaint of shortness of breath. Further work-up diagnostics were done. Echocardiography findings suggestive of large pericardial effusion and echogenic material at the apical right ventricle (RV) with size 4.8x2 cm with normal left and right heart contraction. At first the echogenic material was suspected as RV aneurism with impeding rupture. Due to high-risk profile patients with cardiac tamponade, open heart surgery was done and revealed solid tumor located at the apical RV. After that patient underwent a biopsy and excision of the tumor with ventriculectomy and reconstruction. A pathological exam of tumor reveals a spindle cell tumor with giant cell rich feature and finally decided as cardiac myxoma.

Conclusion: Right ventricular myxomas are exceptionally rare cardiac tumors that pose significant diagnostic challenges due to their atypical location and potential to mimic other life- threatening conditions, such as ventricular aneurysms.

Surgical approach and outcomes of empyema patients in Prof. Ngoerah Hospital: a single-center retrospective observational study

I Gusti Agung Ngurah Hendy Setiawan — 2026-05-18

Background: The number of patients with empyema thoracis is increasing with time despite rigorous prevention methods such as vaccination and antibiotic use. Surgical interventions are often required for advanced cases, though outcomes may differ due to other factors and staging. This study retrospectively evaluates the surgical management and outcomes of patients with empyema.

Methods: We performed a retrospective observational study at Cardiothoracic and Vascular Surgery Divison in Prof Ngoerah Hospital from January 2019 to December 2021. Patients were diagnosed with imaging and pleural fluid analysis and referred to the cardiothoracic and vascuar surgery department. 22 patients were included in this study and had their demographic data, comorbidities, surgical interventions, and outcomes analyzed. An range of interventions was performed such as open thoracotomy, video-assisted thoracoscopic surgery (VATS), or as a combination. Outcomes assessed included the need for repeat surgery, length of hospital stay (LOS), and ICU stay. All data were analyzed using IBM® SPSS 26.0 using univariate descriptive analysis.

Results: Out of the 22 patients (mean age 42.55 years), there were more males than females (68.2%), and half of them came into the hospital with complex empyema (Light’s Category 7). Open thoracotomy was the most common intervention (54.5%), followed by VATS (31.8%). Most patients (81.8%) did not require repeat surgeries. LOS ranged from 2 to 48 days (mean: 17.18), and ICU stays averaged 5.24 days. Comorbidities such as pneumonia (31.8%), tuberculosis (18.2%), and diabetes mellitus (13.6%) were seen.

Conclusion: This study highlights possible barriers in providing optimal care to patients with empyema and its comorbidities and includes late diagnosis for favorable surgical outcomes. This issue is particularly significant, as a substantial proportion of patients continue to present with advanced stages of empyema.

Comparison of efficacy between cutting balloon and conventional balloon angioplasty for arteriovenous shunt stenosis: a meta-analysis

Mada Ilham Bawono — 2026-05-10

Background: Vascular access remains the main challenge in hemodialysis and is frequently complicated by stenosis and restenosis, necessitating effective interventions to maintain vascular patency. Cutting balloon angioplasty has emerged as a newer therapeutic modality. However, the effectiveness of cutting balloon angioplasty versus conventional balloon angioplasty is still an open question. This meta-analysis aims to provide an answer by collecting and analyzing the data available on the matter.

Methods: Cutting balloon and conventional balloon angioplasty were compared in studies only if they were randomized controlled trials; otherwise, the study was non-randomized if high-pressure balloon angioplasty, paclitaxel-coated balloon angioplasty, and vascular access stenting were used. A systematic search was conducted in the databases of PubMed, Scopus, and Web of Science, and the last search was done on August 16, 2025. The studies that were selected were analyzed for bias risk employing the RoB 2 tool. The RevMan 5.4 software was used for data analysis, and the results were given as forest plots.

Results: The final selection consisted of three randomized controlled trials that totaled 549 participants in the cutting balloon group and 536 in the conventional balloon group. The results showed that the target lesion at 6 months primary patency was higher for cutting balloon angioplasty than for conventional balloon angioplasty, with a relative risk of 1.21 (95% CI 1.03–1.40; p = 0.02). However, no significant differences in clinical and anatomical success were noted between the two groups (p>0.05).

Conclusion: The study had limitations due to the comparatively small sample size, which may lead to limited generalizability. However, it also gave an indication that cutting balloon angioplasty might be the better option for treating arteriovenous shunt stenosis.

Venoplasty as a key solution for improving dialysis access: a literature review

Ronald Winardi Kartika — 2026-05-12

Background: Chronic kidney disease necessitates effective dialysis, which relies heavily on the integrity and patency of vascular access. Venoplasty has emerged as a pivotal intervention for maintaining this access. This literature review aims to evaluate venoplasty as a key solution for improving dialysis access.

Methods: This literature review evaluates the mechanisms, indications, clinical outcomes, and procedural efficacy of venoplasty. A comprehensive literature search was conducted for randomized controlled trials and observational studies from the last decade, focusing on success rates, adverse events, and long-term patency.

Results: Venoplasty, utilizing balloon catheters to dilate stenosed veins, demonstrates a success rate of 70–90% in restoring blood flow. This significantly reduces dialysis-related complications and hospitalizations. However, the risk of re-stenosis persists, often necessitating repeat interventions or alternative strategies like stenting in recurrent cases.

Conclusion: Venoplasty remains a cornerstone for managing central venous obstruction in dialysis patients, significantly improving quality of life and reducing intervention frequency. As chronic kidney disease prevalence rises, integrating venoplasty into standard care is essential. Future research should prioritize advanced techniques, such as drug-coated balloons, to enhance durability and address current limitations in treating vascular access failure.