Abstract

In Reply:

I appreciate the review and comments of Drs. Perkowski and Thompson regarding the article by my colleagues and me. ¹ True, the patient in our case report remained hemodynamically stable and virtually asymptomatic with a bullet lodged in the myocardium of the right ventricle for approximately 24 hours. The injury presented in our report, however, is dissimilar to the BB injuries discussed by Thompson et al. ² Retained bullets in the myocardium have a high propensity to erode, resulting in embolization and potentially life-threatening hemorrhage, especially when embedded in the thin-walled right ventricle. Fortunately, the patient in this case did well for the limited observation period. I view his long-term prognosis with a jaundiced eye, however, especially considering the location of the bullet and the patient's potential noncompliance with follow-up recommendations. In my opinion, the elective removal of a bullet embedded in the myocardium is the safest and most prudent course of therapy.