Multidisciplinary rescue of acute cardiac tamponade post VATS: a case report and review of literature.

BACKGROUND

Acute cardiac tamponade is a rare but fatal complication after video-assisted thoracoscopic surgery. This case is noteworthy for its novel mechanism of injury and underscores the critical importance of multidisciplinary management in achieving a successful outcome against high historical mortality rates.

CASE PRESENTATION: A 64-year-old Han Chinese male underwent an uncomplicated video-assisted thoracoscopic surgery right upper lobe wedge resection for lung adenocarcinoma. At 3 hours postoperatively, he developed sudden obstructive shock. Echocardiography confirmed cardiac tamponade. Emergent pericardiocentesis and venoarterial extracorporeal membrane oxygenation stabilization were followed by sternotomy, which revealed a needle-like aortic perforation caused by a malformed staple that had eroded from the pulmonary staple line. The aortic injury was surgically repaired. The patient was successfully weaned from extracorporeal membrane oxygenation on postoperative day 2 and extubated on day 7, making a full recovery, and was discharged on day 19.

CONCLUSION

This case highlights a novel, delayed mechanism of staple-related vascular injury that can occur even after right-sided video-assisted thoracoscopic surgery. It demonstrates that rapid diagnosis, immediate pericardiocentesis, early extracorporeal membrane oxygenation support, and definitive surgical repair within a multidisciplinary framework are paramount for survival. This report advocates for heightened vigilance during stapling near vital structures and reinforces the lifesaving potential of a protocolized rescue approach.