1. “Single suture” for circumflex exposure in off-pump coronary artery bypass grafting 
Jacob Bergsland, MD, Hratch L Karamanoukian, MD, Paulo R Soltoski, MD, Tomas A Salerno, MD 
The Annals of Thoracic Surgery 
Volume 68, Issue 4, Pages (October 1999)
DOI: /S (99)

2. Fig 1
The posterior pericardium is shown in cut view with the “single suture” to be placed in the oblique sinus. The oblique sinus is the cul de sac of posterior pericardium bordered by the right and left superior and inferior pulmonary veins.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
The “single suture” is shown with the snare on tension in a caudal direction in the midline. It is snared flush with the “vaginal pack” in the oblique sinus. The surgeon’s hand is shown lifting the heart out of the chest to expose the oblique sinus. The snare protects the heart from “sewing effect.”
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

4. Fig 3
The “vaginal pack” is shown on the left side of this picture elevating the heart out of the chest. It is clamped to the drapes beyond the retractor. The high marginal vessel has been grafted using this technique and is shown within the forks of the stabilizer.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )