Cardiac herniation following completion pneumonectomy for bronchiectasis

Abstract

Sporadic reports on cardiac herniation are available in the literature; most of them had followed intrapericardial pneumonectomies for malignant pulmonary tumors. We present an uncommon event of heart herniation after a completion pneumonectomy indicated for chronic bronchiectasis. A 35-year-old male patient was operated for left completion pneumonectomy. A 6 cm x 4 cm area of adherent pericardium near the obtuse margin of heart was removed during surgery. During head-end elevation of the bed in postoperative intensive care unit, patient got accidentally tilted to the left side, which resulted in ventricular fibrillation. Chest cavity was re-opened for cardiopulmonary resuscitation. Left ventricle was found herniating through the pericardial deficiency into the left-thoracic cavity with the cardiac apex touching chest wall. During surgical re-exploration, the pericardial deficiency was closed with a synthetic Dacron patch. Hemodynamic condition remained stable in the immediate postoperative period. Patients had infection of the left thoracic cavity after 5 weeks, for which he was subjected to thoracoplasty and omentopexy. Prompt recognition with timely intervention is life saving from cardiac herniation. Strategy of closing the pericardial defect after pneumonectomy should be followed routinely, irrespective of the indication for pneumonectomy.

Double‐Chambered Left Ventricle in Echocardiography

“…8 In our patient, LV outpouching contracted synchronously. 4 LV diverticulum is due to congenital weakness or defect of regional cardiac tissue, and always associate with medline thoracoabdominal defects and other cardiac malformations.…”

“…LV hernia is formed as the absence of the part of pericardium; preoperation diagnosis mainly depended on the history of excision of pericardium. 8 In our patient, LV outpouching contracted synchronously. It is difficult to distinguish whether it is an AC or a muscular diverticulum.…”

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect

“…In this case, the most likely cause of the adverse events appears to be the occurrence of cardiac herniation. The mechanisms and symptoms of cardiac herniation caused by pericardial defect vary depending on whether the defect is right-sided or left-sided [ 2 ]. In a right-sided herniation, dextrorotation of the heart may cause torsion of the atrio-caval junction, compression of the vena cava, and ventricular outflow obstruction, leading to severe decreases in cardiac output.…”

“…In a right-sided herniation, dextrorotation of the heart may cause torsion of the atrio-caval junction, compression of the vena cava, and ventricular outflow obstruction, leading to severe decreases in cardiac output. In a left-sided herniation, pressure may be applied on the myocardium and coronary arteries by the edges of the pericardial defect, causing fatal ventricular outflow obstruction, arrhythmia, and myocardial infarction [ 2 ]. Normally, traction of the lung during adhesiolysis only pulls the pericardium, not the heart itself.…”