Clinical course and comparative analysis of intraoperative visualization in surgical treatment of blind gunshot wounds of the heart

Introduction. Gunshot wound of the heart is a severe surgical pathology with battlefield mortality rate of up to 80%. The authors analyzed clinical course and intraoperative visualization in surgical treatment of blind gunshot wounds of the heart. Material and methods. A retrospective cohort study included 27 patients. Preoperatively, localization of foreign body was determined using echocardiography, chest X-ray and/or computed tomography. Intraoperatively, real-time X-ray imaging (2D C-arc) was performed in group 1 (n=17), and transesophageal echocardiography (TEE) was performed in group 2 (n=10). Results. The most common concomitant injuries were soft tissue (81.5%) and lung (70.4%) lesions, and the entry wound was localized on the chest wall surface. In 14.8% of cases, the entry wound was detected in other areas. Foreign bodies were detected deep in the myocardium of the left or right ventricles in 70.4% of cases. In all cases, the initially determined foreign body localization was confirmed intraoperatively (TEE or 2D C-arc). There were no significant between-group differences depending on the method of intraoperative foreign body diagnostics regarding intraoperative and early postoperative parameters. There were no postoperative complications or mortality. In 3 cases of the 1st group, foreign body migration from the right ventricle was recorded (1 case — pulmonary artery, 2 cases — hepatic vein). Conclusion. Preoperative localization of foreign body in the heart coincides with intraoperative TEE or X-ray (2D-C-arc) data in 100% of cases. The risk of intraoperative migration is 11%, and all cases are associated with baseline localization in the right ventricle. C-arc for angiography is necessary in the operating theater due to the risk of foreign body migration in blind gunshot wounds of the heart.