Arrow lodged in heart: Bhutanese man survives rare cardiac injury after surgery at GNRC

A 42-year-old Bhutanese man survived a rare and life-threatening penetrating cardiac injury after an arrow pierced his chest and became lodged in the right ventricle of his heart. He underwent complex cardiac surgery at GNRC Hospitals, Dispur, after undertaking a 13-hour road journey from Thimphu to Guwahati with the arrow still embedded in his heart.

The patient, referred to as Tashi Dorji (name changed for privacy), sustained the injury during a friendly archery match in Paro, Bhutan. A hard steel arrow penetrated the front of his chest, passed through the breastbone and entered the right ventricle.

He was initially shifted to Thimphu, where a CT scan confirmed that the arrow had penetrated the heart. Doctors in Bhutan subsequently contacted GNRC Hospitals and consulted Dr Rajnish Duara, Director and Chief Cardiac Surgeon at GNRC, who agreed to undertake the high-risk procedure.

The patient was then transported overnight by road from Thimphu to Guwahati and reached GNRC the following afternoon. The arrow remained lodged in his heart throughout the journey.

According to the treating team, removing the arrow while the heart was beating could have caused catastrophic bleeding and resulted in death. The surgical team therefore adopted a controlled approach using cardiopulmonary bypass.

The patient was placed on a heart-lung machine through access to the groin artery and vein. Blood was diverted from the groin vein to the machine, oxygenated and returned through the groin artery, allowing the surgeons to bypass the patient's heart and lungs during the critical stage of the operation.

The breastbone was then divided using a surgical saw, following which the arrow was removed while the patient was on cardiopulmonary bypass. With the heart decompressed, the surgeons repaired the injury to the right ventricle before successfully restoring normal circulation and disconnecting the patient from the heart-lung machine.

The patient's postoperative recovery was reported to be encouraging. He was taken off the ventilator within three hours of the procedure and became mobile from the second postoperative day.

The surgery was led by Dr Rajnish Duara and assisted by Dr Aadarsha Rai, Consultant Cardiac Surgeon.

"Meticulous planning and a safe approach were necessary for the successful surgery," Dr Duara said, describing the case as an exceptionally rare cardiac injury. He also noted that the patient's survival of the injury and the subsequent 13-hour journey to Guwahati made the case particularly challenging.

GNRC Hospitals acknowledged the support extended by personnel of the Embassy of Bhutan in facilitating the patient's transfer to Guwahati and assisting during the postoperative period.

The case also underscores the existing healthcare links between Bhutan and Assam, with patients from Bhutan regularly travelling to Guwahati for specialised medical treatment.

Despite the unusual nature of the incident, the patient reportedly plans to continue archery as a pastime after recovering from his injuries.