Cardiac Herniation after Intrapericardial Pneumonectomy and Subsequent Cardiac Tamponade

Kiev, Jon; Parker, Mark S.; Zhao, Xian; Kasirajan, Vigneshwar

doi:10.1177/000313480707300917

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…Polytetrafluoroethylene (PTFE) patches are preferred because of their strength, simplicity, and the low risk of infection. Prolene mesh is strong and porous and its construction may prevent tamponade by allowing pericardial fluid to leak from the restrictive covering [ 5 ]. We also recommended that direct suturing should generally be avoided because increased tissue tension and the sutured pericardium could be torn again.…”

Section: Discussionmentioning

confidence: 99%

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report

Tong

Zhao

et al. 2021

J Cardiothorac Surg

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Introduction Cardiac herniation is a rare complication after pulmonary surgery, and there are only a few reports about it. We now report a case of cardiac herniation presenting as superior vena cava obstruction after pneumonectomy. Case presentation A-52-years old woman diagnosed right pulmonary squamous cell carcinoma was carried out right pneumonectomy, the pulmonary artery and right superior pulmonary vein were dissected and ligated intrapericardial. The patient developed tachycardia arrhythmias, hypotension, followed by loss of consciousness at about 18 h after operation. After resuscitation, the patient was conscious but developed cyanosis of the superior vena cava drainage area, uropenia, and hypotension (80/30 mmHg). Bedside-echocardiography showed that the SVC was obstructed due to thrombus formation. Chest radiography a shift of the heart into right hemithorax. Rethoracotomy was performed and the herniated heart was replaced into the pericardium, and the pericardium was repaired with Gore Tex patch. The patient recovered smoothly after the second surgery. Conclusion Cardiac herniation is a rare and fatally complication after thoracic surgery, and the prompt recognition with timely intervention is life-saving. Cardiac herniation is a rare but fatal complication of pneumonectomy. The increasing frequency of surgical resection for locally advanced thoracic carcinoma has led to a renewed emphasis regarding early diagnosis and treatment for cardiac herniation. Here we discuss a case of cardiac herniation presented with acute superior vena cava obstruction syndrome and hemodynamic instability after intrapericradial right pneumonectomy.

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Section: Discussionmentioning

confidence: 99%

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report

Tong

Zhao

et al. 2021

J Cardiothorac Surg

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“…However, as spontaneous respiration increased, intrapleural pressure became a strong negative pressure that surpassed the chest drain suction pressure of − 7 cmH 2 O. Additionally, the wound in the chest wall functioned as an antireflux check valve, leading to the development of impending tension pneumothorax [5,6]. Cardiac herniation is a serious postoperative complication of EPP and is reportedly preventable by avoiding mechanical ventilation, hyperinflation of the remaining lung, coughing on extubation, and excessive suction within the chest drainage tubes [8][9][10]. As noted above, this spontaneous respiration conflicted with the chest suction pressure because we had chosen a lower pressure (− 7 cmH 2 O) than the setting typically used for postoperative drainage (− 15 cmH 2 O).…”

Section: Discussionmentioning

confidence: 99%

Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report

et al. 2018

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Background: Cardiac herniation is a serious postoperative complication of extrapleural pneumonectomy (EPP) and is reportedly preventable by reducing the suction pressure of the chest drain. Case presentation: We describe a patient in whom respiratory failure, which was caused by impending tension pneumothorax after EPP, was successfully treated via normal suction pressure of the chest drain. A lower suction pressure (− 7 cmH 2 O) was chosen as an alternative to the setting typically used for postoperative drainage (− 15 cmH 2 O). As a result, the wound in the chest wall functioned as an antireflux check valve, leading to the development of impending tension pneumothorax. Conclusions: Impending tension pneumothorax presents with an abnormal elevation of intrapleural pressure on the affected side. This phenomenon can be effectively treated by increasing the suction pressure in the chest drain.

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A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma

2010

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A 44-year-old man underwent radical thymectomy for malignant thymoma 5 years ago. He subsequently underwent right extrapleural pneumonectomy because a right pleural metastatic lesion had developed. The operation was completed uneventfully. Immediately after arrival at the intensive care unit, the patient appeared restless and in pain. His heart rate increased to 140 bpm and then abruptly decreased to 20-30 bpm concomitant with profound systolic hypotension of 30-40 mmHg. Chest X-ray showed that the heart was shifted into the right thorax. Emergent re-thoracotomy was performed and the heart was found to be malrotated and herniated from an upper defect of the pericardial patch in the right thoracic cavity. The heart was returned to the pericardium and the defect was covered with a pericardial patch. The blood pressure and heart rate became stable. He was transferred to the surgical ward from the intensive care unit on the first postoperative day. The rest of the course was uneventful and the patient was discharged on the seventh postoperative day. The incidence of cardiac herniation after extrapleural pneumonectomy following chemotherapy for malignant pleural mesothelioma has been reported to be around 3%. The risk of cardiac herniation should always be considered, especially after extrapleural pneumonectomy.

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Cardiac Herniation after Intrapericardial Pneumonectomy and Subsequent Cardiac Tamponade

Cited by 6 publications

References 9 publications

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report

Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report

A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma

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