X-Ray after Surgery - Can you guess the surgery?

This is the X-Ray of a man who underwent cardiac surgery one month back. Can you guess the surgery this patient had by looking at the clues in this X-Ray?

If you had a good look you might have noticed the deviated trachea or the arch of aorta but these two findings are not relevant to our case. The real clue is on the left heart border - those little clips!

Arrows highlight the clips

Yes, this is a LIMA (Left Internal Mammary Artery) attached to LAD (Left Anterior Descending Artery). These clips block the branches arising from the LIMA to stop excessive bleeding.

But as you might have noticed, there are no Sternal sutures; the hallmark of cardiac surgery! This brings us to the conclusion: This is a case of MIDCAB (Minimally invasive direct coronary artery bypass) or Minimally Invasive Cardiac Surgery (MICS) with LIMA attached to LAD. It is performed through a small Anterolateral thoracotomy.

Here are a few links if you want to read further:

http://circ.ahajournals.org/content/94/10/2669
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729728/
https://en.wikipedia.org/wiki/Minimally_invasive_cardiac_surgery
http://www.cthsurgery.com/harvesting-internal-mammary-artery-lima.html

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