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Cardiac herniation after left intrapericardial pneumonectomy.

Faouzi Alimi1, Mohamed Marzouk2, Imen Mgarrech2

  • 1Department of Cardiothoracic Surgery, Sahloul University Hospital, Sousse, Tunisia faouzialimi@gmail.com.

Asian Cardiovascular & Thoracic Annals
|June 6, 2015
PubMed
Summary

Postoperative cardiac herniation, a rare complication after pneumonectomy, can cause sudden hemodynamic failure. Urgent surgical repair is critical for survival, even in asymptomatic patients.

Keywords:
Herniacardiogenicpericardiectomypneumonectomypostoperative complicationsshock

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Area of Science:

  • Cardiothoracic Surgery
  • Surgical Complications
  • Cardiology

Background:

  • Postoperative cardiac herniation is a rare but fatal complication following thoracic surgery, particularly after pneumonectomy.
  • It necessitates prompt surgical intervention to reduce the heart and repair the pericardial defect.

Observation:

  • Cardiac herniation occurred 8 hours after a left intrapericardial pneumonectomy in an asymptomatic patient.
  • The patient developed acute hemodynamic failure and electrocardiographic changes despite the absence of symptoms.
  • Chest radiographs were inconclusive in diagnosing the cardiac herniation.

Findings:

  • Surgical exploration revealed cardiac herniation due to a pericardial defect, with the heart strangulated at the atrioventricular groove.
  • Repositioning the heart was performed, but hemodynamic instability persisted due to ischemic injury.
  • Extracorporeal membrane oxygenation (ECMO) was initiated to manage the persistent instability.

Implications:

  • This case highlights the critical need for vigilance and prompt diagnosis of cardiac herniation post-pneumonectomy.
  • It underscores the potential for rapid deterioration even in asymptomatic patients.
  • Early surgical intervention and advanced life support are crucial for managing this life-threatening complication.