Paradoxical embolism of a projectile from the venous to arterial syste
m is a rare occurrence, which can cause diagnostic confusion. We prese
nt a case of venous embolism of a shotgun pellet from the left upper e
xtremity to the noncoronary sinus of the aortic valve across a secundu
m-type atrial septal defect. Prevention of distal embolism of the pell
et was presumably a result of its containment by now vortices created
within the sinuses of Valsalva. (C) 1998 by The Society of Thoracic Su
rgeons.