The per-operative xray revealed that the missing nozzle of the suction tube was indeed within the chest cavity, but xrays obviously cannot reveal the exact location of the item, i.e. within or outside the cardiac chambers v/s within or outside the pericardial space v/s whether it was impacted or perforated through any tissue. In this situation, and since the heart and pericardium had already been sutured closed, the surgical team decided to postpone the recovery of the nozzle until identifying its exact location by further imaging. This situation is known as a "retained surgical foreign body", where the recovery of a missing surgical item is postponed or abandoned in favor of a repeat procedure later on ^1,2.

The post-operative supine A/P and lateral xrays did not provide much additional information, other than that the nozzle far away from the mitral prosthesis. Contrast-enhanced CT provided the complete anatomical location of the nozzle, i.e. within the chamber of the left atrium and without any impaction or perforation, and then it was recovered in a subsequent repeat surgery involving reopening of the sternotomy, pericardiotomy and myocardiotomy sutures.

Retained surgical foreign body (RSFB) is classified as an "almost never event", which means that such an occurrence should "almost never" happen if already known and available precautions are properly followed ^1,3.