Yoon Brian, Grasso Samuel, Hofmann Luke J
Department of Surgery, William Beaumont Army Medical Center, 5005N. Piedras Street, El Paso, TX.
Mil Med. 2018 Sep 1;183(9-10):e307-e313. doi: 10.1093/milmed/usx191.
Firearm-related injuries account for 20% of all injury-related deaths and are responsible for 105,000 injuries annually. The occurrence of bullet emboli to the heart is exceedingly rare. Given the rarity of emboli, controversy exists over management. The primary endpoint of this study is to establish a management algorithm for venous bullet emboli to the heart.
A literature search was performed using PubMed and Google Scholar with the following search terms: cardiac bullet embolus, cardiac missile embolus, and bullet embolus. Any discoverable case report(s) or series after 1960 were included in the review. The following data points were collected: age, sex, presentation, imaging, foreign body entry site, foreign body destination site, management, and outcomes.
Fifty-four articles met our search criteria. A total of 62 patients with thoracic venous bullet emboli were identified with the following distributions: right atrium (9.7%), right ventricle (54.8%), pulmonary arterial tree (32.3%), and intra-thoracic inferior vena cava (3.2%). Only 11.3% of patients had symptoms directly related to the cardiac venous emboli; however, all patients with acute symptoms underwent immediate intervention. Of those patients with bullet emboli to the pulmonary arterial tree, 45% were observed; whereas, only 20% with emboli to the right heart were observed. Those without signs or symptoms usually underwent an intervention (72.7%). Endovascular retrieval was successful in 53% of attempts. Of the endovascular attempts that failed, 28.6% were observed and 71.4% underwent open retrieval. Those who were asymptomatic and observed had no reported adverse sequelae during the follow-up. No mortalities were discovered in this review.
Bullet emboli can prove to be a clinical challenge. Adjuncts such as X-ray, computed tomography, transthoracic, and/or transesophageal echocardiography help establish the emboli location. While observation in the asymptomatic patient is reasonable in some circumstances, most patients undergo removal. Removal of bullet cardiac emboli is safe with the availability of modern techniques.
与火器相关的损伤占所有与损伤相关死亡的20%，每年导致105,000人受伤。子弹栓塞至心脏的情况极为罕见。鉴于栓子的罕见性，在治疗方面存在争议。本研究的主要终点是建立针对心脏静脉子弹栓子的治疗算法。
使用PubMed和谷歌学术进行文献检索，检索词如下：心脏子弹栓子、心脏导弹栓子和子弹栓子。1960年以后发现的任何病例报告或系列研究均纳入本综述。收集以下数据点：年龄、性别、临床表现、影像学检查、异物进入部位、异物到达部位、治疗方法及结果。
54篇文章符合我们的检索标准。共确定62例胸段静脉子弹栓子患者，分布如下：右心房（9.7%）、右心室（54.8%）、肺动脉树（32.3%）和胸段下腔静脉（3.2%）。仅11.3%的患者有与心脏静脉栓子直接相关的症状；然而，所有有急性症状的患者均立即接受了干预。在那些子弹栓子位于肺动脉树的患者中，45%进行了观察；而子弹栓子位于右心的患者中，只有20%进行了观察。那些没有体征或症状的患者通常接受了干预（72.7%）。血管内取出术在53%的尝试中成功。在血管内取出术失败的患者中，28.6%进行了观察，71.4%接受了开放手术取出。那些无症状且接受观察的患者在随访期间未报告有不良后遗症。本综述未发现死亡病例。
子弹栓子可能是一个临床挑战。诸如X线、计算机断层扫描、经胸和/或经食管超声心动图等辅助检查有助于确定栓子位置。虽然在某些情况下对无症状患者进行观察是合理的，但大多数患者接受了取出治疗。随着现代技术的应用，取出心脏子弹栓子是安全的。
