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Graft Anastomotic Bleeding Detected With Transesophageal Echocardiography After Coronary Artery Bypass Grafting: A

Yasuhiro Suda1, Hiroyuki Kamiya2, Hiroshi Makino1

  • 1From the Department of Anesthesiology and Critical Care Medicine.

A&A Practice
|August 19, 2025
PubMed

Insights

Cardiac tamponade after coronary artery bypass graft (CABG) surgery is a serious risk. Transesophageal echocardiography (TEE) successfully identified anastomotic bleeding as the cause in one patient, guiding reoperation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Cardiac tamponade is a severe complication following cardiac surgery, with reported incidence rates between 0.8% and 4.9%.
  • Coronary artery bypass graft (CABG) surgery carries a specific risk of cardiac tamponade, occurring in approximately 0.2% of cases.

Purpose of the Study:

  • To report a case of cardiac tamponade occurring post-coronary artery bypass graft (CABG) surgery.
  • To highlight the diagnostic utility of Transesophageal Echocardiography (TEE) in identifying the source of bleeding in post-CABG cardiac tamponade.

Main Methods:

  • A 74-year-old female patient developed cardiac tamponade five hours after undergoing on-pump arrested heart CABG.
  • Transesophageal Echocardiography (TEE) was performed to evaluate the cause of the tamponade.

Main Results:

  • TEE revealed significant pericardial hemorrhage causing left atrial compression and ventricular diastolic collapse.
  • The echocardiography identified fresh hemopericardial effusion originating from the saphenous vein graft (SVG) and right posterior lateral branch (RPL) anastomosis, with visible small jets of blood flow.

Conclusions:

  • Transesophageal Echocardiography (TEE) is an effective tool for diagnosing the cause of cardiac tamponade after CABG surgery.
  • Early identification of anastomotic bleeding via TEE is crucial for guiding surgical reexploration and management strategies.

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