Cardiac displacement after lobectomy in a patient with a congenital complete left-sided pericardial defect

A 74-year-old man underwent left upper lobectomy for a suspected lung cancer. At thoracotomy, the pericardium was found to be completely absent. The heart was fixed in a central position with an artificial patch to prevent displacement. However, the heart became displaced just after closure of the thoracotomy. The thoracotomy was immediately reopened. The anchor points of the patch on the adventitia of the descending aorta had pulled through. The heart was fixed to the surrounding mediastinal tissues with a larger patch using pledget-reinforced mattress sutures. Because simple closure may result in cardiac herniation due to the cardiac pulsations, congenital pericardial defects should be securely repaired when encountered.