Intrathoracic hemorrhage by deep pericardial sutures as detected by transesophageal echocardiography: report of two cases

BACKGROUND: The use of deep pericardial suture (DPS) is a widely used technique to lift the heart and expose the targeted vessels during off-pump coronary artery bypass grafting (OPCAB). Several reports alert massive bleeding due to DPS, especially for the patients with perioperative administration of tissue plasminogen activator, low molecular weight heparin, and administration of double antiplatelet agents. CASE PRESENTATION: We report two cases of bleeding followed by huge hematoma formation in the left thoracic cavity caused by DPS during OPCAB. In one, bleeding was caused by damage to the left lower pulmonary vein and damage to the diaphragmatic artery in the other. Transesophageal echocardiography (TEE) is a potent tool for detecting complications and identifying the location of bleeding. CONCLUSIONS: TEE is useful for finding hemorrhagic complications and for determining the points of bleeding based on the location of the hematoma.