Anesthetic Management of a Crossbow Bolt Injury to the Heart

Although arrow injuries caused by hunting or tribal fighting are still seen in developing countries, cardiac injuries due to arrow piercing—and survival after removal—are extremely rare. 1 Karger B. Sudhues H. Brinkmann B. Arrow wounds: Major stimulus in the history of surgery. World J Surg. 2001; 25: 1550-1555 Crossref PubMed Scopus (16) Google Scholar , 2 Fingleton L.J. Arrow wounds to the heart and mediastinum. Br J Surg. 1987; 74: 126-128 Crossref PubMed Scopus (35) Google Scholar , 3 vanGurp G. Hutchison T.J. Alto W.A. Arrow wound management in Papua New Guinea. J Trauma. 1990; 30: 183-188 Crossref PubMed Scopus (28) Google Scholar , 4 Jacob O.J. Penetrating thoracoabdominal injuries with arrows: Experience with 63 patients. Aust N Z J Surg. 1995; 65: 394-397 Crossref PubMed Scopus (25) Google Scholar The authors present a case of a 29-year-old male with a self-inflicted cardiac injury caused by a crossbow bolt. The projectile entered through the left anterior chest between the fourth intercostal space parasternally, piercing the left ventricle and diaphragm, and lodging into the lateral segmental branch of the left hepatic lobe. Compared with gunshot wounds, arrow injuries are less destructive but are fatal if these are removed in the prehospital setting. 5 Karger B. Sudhues H. Kneubuehl B.P. et al. Experimental arrow wounds: Ballistics and traumatology. J Trauma. 1998; 45: 495-501 Crossref PubMed Scopus (68) Google Scholar The authors discuss the use of intraoperative transesophageal echocardiography (TEE) in detecting complications such as intracardiac shunt, abnormal wall motions due to coronary artery injury, valvular rupture, and detection of the residual fragmentation of the projectile.