[Heart dislocation following extensive lung resection with partial pericardial resection]

Cardiac herniation is a rare but dramatic complication of pulmonary resection that demands urgent treatment. About 50 patients have been reported in the literature; 50% of them died. Symptoms vary depending on the location of the pericardial defect. Cardiac output falls, central venous pressure rises, and cyanosis develops that does not respond to oxygen administration. Right-sided herniation is characterized primarily by decreased blood pressure and tachycardia due to kinking or torsion of both superior and inferior venae cavae and subsequent reduction of cardiac filling. Left-sided herniation more often produces ischemic ECG changes and dysrhythmias due to jamming of the ventricles between the edges of the pericardial defect. Without intervention irreversible myocardial damage may rapidly result. Luxation typically arises at the end of the operation or in the early postoperative period. Precipitating factors are suction on the chest tube, changes in the patient's positioning, positive pressure ventilation to expand the remaining lung segments, coughing and extubation. In right-sided luxation an anteroposterior chest X-ray will substantiate the diagnosis without difficulty; in left-sided luxation the chest film may not show a similarly striking finding. Often dramatic deterioration in the patient's status may not allow time for diagnostic procedures. In case of doubt, immediate rethoracotomy is indicated. In the case observed, a 47-year-old woman underwent right pleuropneumonectomy with partial pericardectomy and intrapericardial ligation of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)