Bullets in the Heart

Laymen have always been inclined to regard a bullet or a metal fragment in the heart as a sentence of death. And until World War I, most surgeons agreed. Sometimes they could remove the offending object and the patient would live--but the operations were often as deadly as the fragments. Now a 20-year follow-up of World War II injuries shows that, despite all surgery's advances, in many cases it is still better to leave a bullet in the heart.

Zipper Fragments. It is a good rule to leave a foreign body alone unless the heart continues to rebel against its presence, report Dr. Edward F. Bland of Massachusetts General Hospital and Dr. Gilbert W. Beebe of the National Academy of Sciences-National Research Council. The heart usually accommodates itself to any hunk of metal that does not interfere with the working of a valve.

One of the 40 veterans described by Bland and Beebe in the New England Journal of Medicine suffered his heart wound at the age of 13 while hunting rabbits. A .22-cal. bullet entered his chest but was removed, and he made such a good recovery that at 18 he was inducted into the Army and fought in Tunisia. Under combat stress, he developed chest pains, and X rays revealed 13 metallic fragments in his chest, three within the heart wall itself. Without surgery, he recovered enough to fight in France and win a Silver Star. Now he works full time as a house painter. The metal fragments that he still harbors are, it appears, parts of the zipper on his hunting shirt that were propelled into his chest by the bullet in 1936.

In only eight cases was removal of the fragments attempted, and in five the effort had to be abandoned. In one patient, who was opened up twice, a husky piece of metal was too deeply embedded in the right ventricle wall to permit removal. This man, now 42, works part time, and his main complaint is that he was twice subjected to unnecessary surgery. Not one of the 40 men has developed the agonizing pain of angina pectoris. All but two have normal electrocardiograph tracings. Though understandably apprehensive, all but five are working, at least part time, some at active jobs.

Pendulum Swing. The most remarkable case is that of a soldier who was 28 when he took a bullet in the heart at Bastogne. Two quarts of blood had to be drawn from his punctured chest, and not surprisingly, he has had his share of lung trouble. But after more than 20 years, his ECG is normal, although X rays show the bullet still firmly lodged in the back wall of his left ventricle. There it swings, pendulum fashion, with each heartbeat. Though the veteran sometimes suffers from short ness of breath and dizziness, his main trouble is anxiety. And as with four others among the 40 cases, say the investigators, it is the anxiety, not the metal in his heart, that has kept him from working.

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