title: Thoracoscopic removal of a suture needle from the posterior pericardium after coronary artery bypass grafting.
abstract: We demonstrate a minimally-invasive thoracoscopic approach [video-assisted thoracic surgery (VATS)] for removal of a retained pericardial suture needle after standard coronary artery bypass grafting (CABG) surgery. A 46-year-old male presented with unstable angina. His workup demonstrated significant coronary artery disease for which he underwent a six vessel CABG, including entering the left chest for preparation of the left internal mammary artery (LIMA). At seven weeks, a postoperative chest X-ray demonstrated a foreign body (suture needle) present in the cardiac silhouette. Further computed tomography (CT)-scan imaging confirmed the suture needle to be localized in the left inferior-posterior pericardium. The patient underwent a left VATS exploration for removal of the suture needle. The pericardial suture needle was successfully retrieved thoracoscopically. The chest tube was removed on the first postoperative day and the patient was discharged to home on the second postoperative day. The patient's postoperative course and recovery were uneventful. A minimally-invasive approach can be undertaken for the removal of a foreign body even after prior open chest surgery, avoiding the associated morbidity of a repeat sternotomy.
authors.affiliation: Department of Surgery, Case Medical Center/University Hospitals, Cleveland, OH 44106-5011, USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Liu
authors.forename: Robert
authors.initials: R
authors.lastname: Gilkeson
authors.forename: Alan
authors.initials: A
authors.lastname: Markowitz
authors.forename: Carsten
authors.initials: C
authors.lastname: Schröder
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation*; D005547:Foreign Bodies / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010496:Pericardium / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome