Tricuspid bullet embolism: lessons learnt from a rare firearm sequelae

What we did and why Cardiothoracic surgery was consulted, and a formal transthoracic echocardiography (TTE) was completed, now showing a bright 2.3×1.3 cm echodense object in the right atrium with collapsed inferior vena cava (IVC). The patient was placed on cardiopulmonary bypass and a right atriotomy was performed where the bullet was found entangled in the tricuspid valve leaflet and posterior leaflet. Given these findings, our patient’s bullet likely embolized in transit to the hospital as there were no myocardial surface injuries.