Post CABG X-ray chest PA view

Post CABG X-ray chest PA view

Post coronary artery bypass chest X-ray PA view: Chest X-ray PA view after coronary artery bypass showing the sternal wires and clips used for occluding the side branches of the left internal mammary artery. The magnified views are given below for better delineation.

Sternal wires are used to hold the two sides of the sternum divided during midline sternotomy together for the initial few months during which firm bony union occurs. This reduces sternal instability and chance for sternal wound dehiscence. Occasionally one of these wires can get infected and erode outside the skin, necessitating removal at a later date.

Clips are used to occlude the side branches of the left internal mammary artery (LIMA) which is used for grafting the stenotic left anterior descending artery. The branches removed are the anterior intercostal arteries.

Bello SO et al checked whether routine chest X-ray (CXR) during follow up after cardiac surgery is useful [1]. In their retrospective study group of 350 patients, 271 patients had CXR. Of these, 83 were for clinical indications. CXR led to alteration of management in 33 patients. Alteration in management occurred in 40% of cases when CXR was taken for a clinical indication, but only 12% overall. There was good correlation between clinical indication based CXR and resulting change in management. Authors concluded that CXR should be performed during routine follow up of adult cardiac surgical patients using a patient centered approach based on signs and symptoms.

Reference

1. Bello SO, Page A, Sadat U, Codispoti M, Nair SK. Chest X-ray and electrocardiogram in post-cardiac surgery follow-up clinics: should this be offered routinely or when clinically indicated? Interact Cardiovasc Thorac Surg. 2013 Jun;16(6):725-30. doi: 10.1093/icvts/ivt017. Epub 2013 Feb 20. PMID: 23429568; PMCID: PMC3653455.