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Case report: cardiac herniation following robotic-assisted thymectomy
John Espey1, Stephen Acosta2, Lavinia Kolarczyk2
1Department of Cardiothoracic Surgery, University of North Carolina-Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27705, USA. John.Espey@unchealth.unc.edu.
Journal of Cardiothoracic Surgery
|April 2, 2020
Summary
Cardiac herniation is a rare but fatal complication after pericardial resection during surgery. This case highlights its occurrence after thymectomy, emphasizing the need for prompt recognition and repair with pericardial patching.
Area of Science:
- Cardiothoracic Surgery
- Surgical Complications
- Medical Case Reports
Background:
- Cardiac herniation, a rare and potentially fatal complication, has been documented following pericardial incision or resection.
- Literature primarily consists of case reports after intrapericardial pneumonectomy, with no prior reports following thymectomy with pericardial resection.
Observation:
- A patient with myasthenia gravis underwent robotic-assisted thymectomy with partial pericardial resection.
- Acute hypotensive shock occurred post-operatively, revealing partial cardiac herniation through the pericardial defect.
- Emergent sternotomy and manual reduction of the heart were performed, followed by pericardial defect closure with a Gore-Tex patch.
Findings:
- This case represents the first reported instance of cardiac herniation following thymectomy with pericardial resection.
- Hemodynamic instability post-surgery indicated the presence of cardiac herniation.
- Successful management involved emergent surgical intervention and pericardial reconstruction.
Implications:
- Cardiac herniation should be considered in cases of hemodynamic instability after surgeries involving pericardial resection.
- Routine use of pericardial patches for defects larger than 3x3 cm, particularly those extending inferiorly, is recommended to prevent this complication.
- Robotic surgical systems can facilitate the routine placement of pericardial patches.
