Bullet embolus to the heart: A case report and systematic review of the literature.

Gun violence is a significant contributor to morbidity and mortality worldwide. Intravascular and intracardiac bullet emboli are a rare but recognized phenomenon; however, the optimal management of intracardiac bullet emboli remains unclear. In this article, we report a unique case of a bullet embolus to the mitral annulus and a systematic review of the literature on intracardiac bullet emboli. Our case involves a patient who sustained multiple gunshot wounds, including an intracardiac bullet embolus to his left ventricle that was identified and managed non-operatively. Blood lead levels increased slightly with the bullet left in situ but did not reach toxic levels. In our systematic review, we identified 56 articles encompassing 61 cases of intracardiac bullet emboli. The majority of previous cases reported emboli to the right ventricle (78.7 %) or right atrium (18.0 %). Management strategies varied, with 54 % of cases managed surgically, 27.9 % managed non-operatively, and 16.4 % managed endovascularly. Serial measurement of blood lead levels was uncommon among previous cases but is important to consider in order to avoid long-term lead toxicity in patients with conservatively managed emboli. This unique case report and review of the literature highlights the diagnostic and management challenges associated with intracardiac bullet emboli.