Cardiac herniation following intrapericardial pneumonectomy

Cardiac herniation is a rare, highly lethal complication of intrapericardial pneumonectomy, demanding urgent treatment. The condition presents in the immediate or early postoperative period. Cardiovascular collapse is invariably present. Elevation of the jugular venous pressure and cyanosis in the drainage area of the superior vena cava are frequently noted. ECG may demonstrate the abnormal position and some ischemia of the heart. The effects of cardiac herniation are due to a combination of cardiac malposition, with subsequent torsion of the great vessels, obstruction to the outflow of blood from the heart and strangulation of the prolapsed ventricles by the borders of the pericardial defect. The diagnosis rests on an awareness of this condition, its clinical manifestations and radiological examination. Urgent reduction of the herniated heart gives the only possibility of survival. Prevention of possible recurrence must be considered.