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Background <p>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.</p> Case presentation <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月31日

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  • Chao Gao,
  • Chun Li,
  • Xinpei Liu,
  • Wei Cheng,
  • Yang Guo,
  • Qiuyan Duan,
  • Fei Wang,
  • Jie Zhang,
  • Shengjie Zhang,
  • Jing Du,
  • Xingrong Liu,
  • Naixin Liang

摘要

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.