Abstract
BACKGROUND: Russia-Ukraine war is associated with various kinds of ballistic injuries because of the application of all kinds of weapons. Gunshot injury to the heart and pericardium is rare and associated with high mortality. The video-assisted thoracoscopy surgery (VATS) is rarely performed in combat settings. The aim of the report was to investigate and demonstrate the approach to manage severe gunshot injury to the heart with damage to the pericardium by using VATS and surgical magnets in a combat patient injured in the battlefield area of the Russo-Ukrainian war. CASE PRESENTATION: A 43-year-old male patient received a gunshot injury to the chest in a battlefield area in East Ukraine. 60 min after the injury, the patient was evacuated to the forward surgical team. The patient was evaluated at the Role 3 hospital in Kharkiv. VATS pericardial window (fenestration) was performed, followed by removal of the bullet from the pericardial sac as well as chest re-draining by Bulau under general anesthesia. The patient was discharged on the 12th day after the injury. CONCLUSIONS: The ballistic injuries in the ongoing Russo-Ukrainian war are severe and associated with rare wounds to the pericardium. The CT scan and X-ray under a C-arc machine are useful diagnostic tools for the identification of bullets or other projectiles. VATS and surgical magnets might be considered for selected patients for the management of gunshot injuries to the heart in combat patients.