Case report: cardiac herniation following robotic-assisted thymectomy

Espey, John; Acosta, Stephen; Kolarczyk, Lavinia; Long, Jason

doi:10.1186/s13019-020-01093-3

Cited by 5 publications

(3 citation statements)

References 12 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cardiac herniations have been reported as presenting with inferior myocardial ischaemia [ 8 ] which although absent in our patient, could have been a consequence had there not been an early suspicion of torsion or herniation. Whilst more commonly described post intrapericardial pneumonectomy and thoracic trauma, cardiac herniation can be a complication following even minimally invasive thymectomy [ 9 ] and cardiac surgery [ 10 ]. Furthermore, it is possible that applying negative pressure drainage post lobectomy, may have exacerbated herniation, in an otherwise smaller cavity bound by a raised hemidiaphragm.…”

Section: Discussionmentioning

confidence: 99%

Cardiac herniation post left upper lobectomy and thymectomy: a case report

Jhala,

Thomas

2024

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Cardiac herniation occurs when there is a residual pericardial defect post thoracic surgery and is recognised as a rare but fatal complication. It confers a high mortality and requires immediate surgical correction upon recognition. We present a case of cardiac herniation occurring post thymectomy and left upper lobectomy. Case presentation Initial presentation: A 48-year-old male, hypertensive smoker presented with progressive breathlessness and was found to have a left upper zone mass confirmed on CT biopsy as carcinoid of unclear origin. PET-CT revealed avidity in a left anterior mediastinal area, left upper lobe (LUL) lung mass, mediastinal lymph nodes, and a right thymic satellite nodule. Intraoperatively: Access via left thoracotomy and sternotomy. The LUL tumour involved the left thymic lobe (LTL), left superior pulmonary vein (LSPV), left phrenic nerve and intervening mediastinal fat and pericardium, which were resected en-masse. The satellite nodule in the right thymic lobe (RTL) was adjacent to the junction between the left innominate vein and superior vena cava (SVC). The pericardium was resected from the SVC to the left atrial appendage. Clinical deterioration: Initially the patient was doing well clinically on day 1, however there was sudden bradycardia, hypotension, clamminess, and oligoanuria, with raised central venous pressures and troponins. ECG: no capture in leads V1-2, but positive deflections seen on posterior leads. Echo: no acoustic windows, but good windows seen posteriorly. CXR: left mediastinal shift. Redo operation: After initial resuscitation and stabilisation on the intensive care unit, on day 2 a redo-sternotomy revealed cardiac herniation into the left thoracic cavity with the left ventricular apex pointing towards the spine, and inferior caval kinking. After reduction and repair of the pericardial defect with a fenestrated GoreTex patch, the patient recovered well with complete resolution of the ECG and CXR. Conclusion Cardiac herniation can even occur following sub-pneumonectomy lung resections and should be considered as a differential when faced with a sudden clinical deterioration, warranting early surgical correction.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac herniation post left upper lobectomy and thymectomy: a case report

Jhala,

Thomas

2024

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Various reports included use of a vented Gore-Tex patch for pericardial reconstruction, interrupted vs. running sutures, and suture type (proline vs. V-Loc) varied by institution ( 15 , 17 ). The thoracic department at University of North Carolina reported routinely reconstructing pericardial defects greater than 3 cm × 3 cm ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

A 9 cm robotic thymectomy and pericardial repair case report

Kodia¹,

Nguyen²,

Villamizar³

2020

Mediastinum

View full text Add to dashboard Cite

In the modern surgical era, improved technology has allowed for the increasing use of the robotic platform for thymoma resection. Historically, tumors >5 cm were deemed inappropriate for minimally invasive approaches; thoracic surgeons, however, have become adept with performing increasingly complex thymectomies using minimally invasive techniques. Excision of large thymomas using the robotic platform is no longer considered a rare event, however few publications have described the use of minimally invasive surgery for en bloc excision of the pericardium with mesh reconstruction. We present a case of an asymptomatic, incidentally discovered 9 cm thymoma involving the pericardium and right lung upper lobe that was resected via bilateral robotic-assisted thymectomy en bloc with wedge resection and pericardial resection with mesh reconstruction. The case highlights the use of the robotic platform to avoid a conversion to open thymectomy. The patient was discharged home on postoperative day 3 with minimal pain and narcotic requirement. We aim to contribute to the existing literature supporting the use of the robotic platform during complex thymectomy. The associated video presentation serves as a visual instructional guide for the thymoma resection, en bloc with the right upper lobe and pericardium and the pericardial reconstruction. This minimally invasive technique has been associated with shorter hospital stay, reduced pain and faster recovery.

show abstract

“…Cardiac herniations have been reported as presenting with inferior myocardial ischaemia [8] which although absent in our patient, would have been a likely consequence had there not been an early suspicion of torsion or herniation. Whilst more commonly described post intrapericardial pneumonectomy and thoracic trauma, cardiac herniation can be a complication following even minimally invasive thymectomy [9] and cardiac surgery [10] .…”

Section: Recognition and Diagnosismentioning

confidence: 99%

Cardiac herniation post left upper lobectomy and thymectomy: A Case Report

Jhala,

Thomas

2023

Preprint

View full text Add to dashboard Cite

BACKGROUND: Cardiac herniation occurs when there is a residual pericardial defect post thoracic surgery and is recognised as a rare but fatal complication. It confers a high mortality and requires immediate surgical correction upon recognition. We present a case of cardiac herniation occurring post thymectomy and left upper lobectomy. CASE PRESENTATION: Initial presentation: A 48-year-old male, hypertensive smoker presented with progressive breathlessness and was found to have a left upper zone mass with a widened mediastinum on chest radiograph (CXR). PET-CT revealed avidity in a left anterior mediastinal and left upper lobe (LUL) lung mass, with mediastinal lymph nodes, with a right thymic satellite nodule. Intraoperatively: Left thoracotomy (access) and Sternotomy (retrieval): The LUL tumour involved the left thymic lobe (LTL), left superior pulmonary vein (LSPV), left phrenic nerve and intervening mediastinal fat and pericardium, which were resected en-masse. The satellite nodule in the right thymic lobe (RTL) was adjacent to the junction between the left innominate vein and superior vena cava (SVC), resected separately. The pericardium was resected from the SVC to the left atrial appendage. Clinical deterioration: Initially the patient was doing well clinically on day 1, however there was sudden bradycardia, hypotension, clamminess, and oligoanuria, with raised central venous pressures and troponins. ECG: no capture in leads V1-2, but positive deflections seen on posterior leads. Echo: no acoustic windows, but good windows seen posteriorly. A CXR showed left mediastinal shift insinuating cardiac herniation. Redo operation: After initial resuscitation and stabilisation on the intensive care unit, on day 2 a redo-sternotomy revealed cardiac herniation into the left thoracic cavity with the left ventricular apex pointing towards the spine, and inferior caval kinking. After reduction and repair of the pericardial defect with a fenestrated GoreTex patch, the patient recovered well with complete resolution of the ECG and CXR. CONCLUSION: Cardiac herniation can even occur following sub-pneumonectomy lung resections and should be considered as a different when faced with a sudden clinical deterioration, warranting immediate surgical repair.

show abstract

Case report: cardiac herniation following robotic-assisted thymectomy

Cited by 5 publications

References 12 publications

Cardiac herniation post left upper lobectomy and thymectomy: a case report

Cardiac herniation post left upper lobectomy and thymectomy: a case report

A 9 cm robotic thymectomy and pericardial repair case report

Cardiac herniation post left upper lobectomy and thymectomy: A Case Report

Contact Info

Product

Resources

About