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Patients can live with pellet lodged in heart, doctors say
Scripps Howard News Service


February 15, 2006

A shotgun pellet, even one not much larger than a grain of pepper, lodged in or near the heart muscle, is potentially a very serious condition, but often something a person can live with for years, medical experts said Tuesday.

The announcement that 78-year-old Harry Whittington had a birdshot pellet in or touching his heart after being shot by Vice President Dick Cheney in a Saturday hunting accident heightened an already high level of concern about the incident around the country.




Doctors at Christus Spohn Hospital Corpus Christi-Memorial in Texas said they discovered the tiny pellet after tests showed Whittington had an irregular rhythm in the upper two chambers of his heart and had experienced what they termed a "minor" or "silent" heart attack they attributed to the presence of the pellet.

But after doing a cardiac catheterization procedure in which dye was injected into the veins leading to the heart that helped detect the presence of the pellet, doctors overseeing Whittington's care chose to leave the projectile in place.

"The BB is in a fixed position, it's not mobile," Dr. David Blanchard, the hospital's emergency-room chief, told reporters in a televised briefing outside the hospital.

"I'd have to agree with their decision to leave it embedded if it's not causing a problem. A small pellet is probably inconsequential and extracting could cause more damage than leaving it in place," said Dr. Thomas Gleason, a cardiothoracic surgeon at Northwestern University Memorial Hospital in Chicago, who has been following the case only through news reports.

The medical team in Corpus Christi, Texas, had reported that Whittington sustained birdshot wounds to his face, neck, chest and rib cage from the shot Cheney took at a quail from about 30 yards away.

Team members have given no estimate of how many of the several hundred round pellets typically contained in a birdshot shell had actually penetrated the skin of the prominent Austin lawyer, but had said they did not plan to remove several of the pellets as Whittington was moved to a "step-down" unit from the hospital's intensive-care unit early Tuesday.

He was returned to the ICU after the catheterization was done and is now expected to remain in the hospital for at least another week as doctors monitor his heart and attempt to make sure that more shot doesn't migrate to other organs.

Although hospital officials mentioned that the pellet had "moved" to Whittington's heart, Dr. Soumitra Eachempati, a trauma surgeon at New York Presbyterian-Weill Cornell Hospital said it was not clear whether the birdshot had somehow penetrated deeper into the chest cavity to reach the heart, or if it had been lodged elsewhere and carried to the heart through a vein.

Eachempati said there are many documented cases of shotgun pellets "embolizing" through the veins to reach vital organs, including the brain, which could result in a stroke, and that this threat would be a major reason to continue close observation of Whittington.

"On the other hand, he could live for years with this one piece of shot in the heart muscle," the surgeon added.

One the best-known victims of a shotgun hunting accident to make a dramatic recovery was cyclist Greg LeMond, who went on to twice win the Tour de France with two pellets still lodged in the lining of his heart after a 1987 accident in California.

Gleason agreed that there are a number of documented cases of patients carrying projectiles in their hearts for years with no serious consequences.

But, again cautioning that he had no direct knowledge of Whittington's case, he noted that "I'm not convinced from what I heard that the pellet in the atria necessarily cause the fibrillation or the heart attack. There are many possible causes for that in a 78-year-old patient."


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