Trajectory Matters: A Case of Bullet Extraction From the Heart via a Median Sternotomy

Cureus. 2025 Nov 26;17(11):e97820. doi: 10.7759/cureus.97820. eCollection 2025 Nov.

Abstract

A 37-year-old man presented with a gunshot wound to the left chest. Initial evaluation revealed no exit wound, and a left anterolateral thoracotomy was performed, revealing a right ventricular injury. A transesophageal echocardiogram (TEE) identified the bullet lodged in the right ventricle near the septal leaflet of the tricuspid valve. Given the bullet's trajectory, a median sternotomy was performed for the removal of the bullet and the repair of the ventricular septal defect. The patient made a full recovery postoperatively. This case highlights the critical role of anticipating and understanding bullet trajectory in guiding surgical decision-making and optimizing patient outcomes.

Keywords: cardiac surgery; cardiac trauma management; chest trauma; emergency cardiac surgery; penetrating cardiac injuries; penetrating chest trauma; trajectory of injury; traumatic cardiac injury.

Publication types

  • Case Reports