LAUSR

atrium (RA) with a moderate pericardial effusion (Figure 1). A transesophageal echocardiogram demonstrated the pericardial effusion with tamponade physiology and a stent which occupied the entire length of the RA and abutted the tricuspid valve (Figure 2). At the time of surgery, a mediansternotomy was performed and 500mL of blood was evacuated from the pericardial space. The stent was noted to be protruding from the RA. Following cardiopulmonary bypass (CPB), a 10-cm bare metal stent was removed from the RA (Figures 3 and 4). After discontinuing CPB, the patient developed a profound protamine reactionwith severe pulmonary hypertension and right heart failure. An intra-aortic balloon pump (IABP) was inserted and the chest was left open. The patient improved hemodynamically and the chest was closed the following day and the IABP was subsequently removed. The remainder of the postoperative course was uncomplicated. He remains asymptomatic 6 months after surgery on coumadin. FIGURE 1 Computed tomography scan; white arrow shows foreign body (embolized iliac stent), and arrow head shows pericardial effusion